Evaluation of community directed vector control on transmission of Onchocerca volvulus in a Loa loa co-endemic region
This study will pilot the Slash and Clear methodology in an oncho-Loa loa co-endemic setting. Previous pilots in Uganda and Nigeria have demonstrated that this simple strategy of removing breeding sites can result in significant black fly reductions that last for several months. This study will provide important data on the impact of Slash and Clear on black fly biting, and consequently its impact on oncho elimination. Two intervention and one control community will be compared for two years, with repeated measurements being taken of biting rates.
To determine the appropriate serologic threshold(s) to be used to initiate MDA for onchocerciasis
Utility of screening easy to access population sub groups as a surveillance tool in monitoring interruption of LF transmission
The question of how to conduct post-elimination surveillance is a high priority for the NTD community, given that most NTD programs scale back or shut down completely once elimination as a public health problem is achieved. Few solutions exist and this proposal provides an interesting and useful case study for surveillance moving forward. The study team plans to target 1708 pregnant women as a proxy for measuring LF resurgence in a post-elimination context. As a comparison group, they plan to conduct a prevalence survey of 427 households (1708 participants) in the same community to compare LF prevalence found in each methodology. Each participant at the health facility’s residence will be geo-referenced to understand the coverage area. They also plan to conduct interviews with patients and health workers, a time-motion study, and a cost analysis to assess the additional burden on health care workers and the health system. The study will occur in 14 facilities in one district of Malawi where LF was highly endemic prior to the launch of the program.
Urban dwellers have frequently been included as "hard to reach" when examining MDA coverage and uptake. Poor coverage in urban settings is a key factor that prevents programs in some settings from achieving success. This research study proposes a community-based participatory action research (CBPAR) strategy to better understand the reasons why this population isn’t reached and/or their decision not to participate in onchocerciasis and lymphatic filariasis MDAs. The results will help identify last mile strategies for urban populations and will generate a technical toolkit for how to conduct rapid participatory research in areas that require novel outreach methods amongst hard-to-reach populations. This form of social science methodology has not been used frequently within the NTD community and this proposal offers an opportunity to build the evidence base for these methods within the context of hard to reach populations.
The researchers plan to conduct a number of activities in order to determine the effectiveness of the participatory approach in targeting urban populations as compared to the standard mobilization and delivery approach.
- Rapid ethnographic interviews, a new technique aimed at rapidly collecting and analyzing qualitative data, to gather community feedback regarding barriers in accessing treatment
- An intervention development workshop with community leaders, health workers, researchers, and the ministry of health
- Deliver the newly designed strategy in Za-Kpota district and compare coverage in urban settings to Ouinhi district
- Finalize a rapid participatory approach toolkit and conduct a time-motion study of the approach to improve the business case to the MoH for uptake 5. Surveys and individual interviews with key stakeholders to determine acceptability, appropriateness, and feasibility of the proposed approach and toolkit
A knowledge co-production strategy to address systematic non-compliance with MDA for Lymphatic Filariasis in Leogane, Haiti
The researchers propose taking a novel approach to increase coverage and reach previously neglected populations by engaging non-compliant individuals in devising a more effective strategy through a technique called knowledge co-production. The researchers plan to address the following questions:
- Can an intervention package co-produced with systematically non-compliant individuals result in increased MDA coverage between the 2019 and 2020 LF MDA rounds?
- Who and where are the systematic non-compliers in Leogane and Gressier?
- What are the reasons motivating systematic non-compliance?
- Is MDA non-compliance associated with hotspots of LF transmission?
The researchers plan the following activities:
- A household cluster survey with 1300 individuals of all ages. This will define coverage in the past MDA and identify non-compliant individuals. In addition, ‘hidden’ non-compliers (NCs) will be located by a networking approach (respondent-driven sampling [RDS]).
- All NCs will then be eligible to be selected into groups of 10 by age (18-25; 26-50; >50), sex (M, F) and demography (urban/rural). These 12 groups will each work with the national health team to devise new approaches to the non-compliance issue. These will be put into place for the 2020 MDA and then assessed by the co-production strategy groups. After the 2020 MDA a second survey will occur to assess impact.
- The relationship between non-compliance and hotspots will be assessed using spatial analysis and defined serologically (FTS and DBS for antibodies) in collaboration with CDC.
Haiti, like many other countries, has made considerable progress in the elimination of lymphatic filariasis. To date, 118 out of 140 communes have passed TAS and stopped MDA. However, little is understood about why some communes have persistent transmission despite five or more rounds of MDA. The proposed study aims to identify alternative approaches to MDA that may help to increase access, uptake, and coverage, particularly for individuals who typically do not comply with MDAs. This cluster-randomized design will test a novel approach (door to door strategy) against the standard health post-based delivery method. Additionally, the study aims to identify non-compliant individuals and better understand their reasons for non-participation. Furthermore, a cost analysis will be undertaken as part of this study to understand the potential implications for the country program should the door-to-door strategy prove effective in reaching higher numbers of people.
Integrating NTD programme monitoring into routine health systems data: evaluating a DHIS2 platform for real-time mass administration of medicines (MAM) reporting
This study includes an assessment of the Sightsavers rollout of a DHIS2 based tool for data collection in the NTD program in 2 states in Nigeria. In particular, the research project seeks to evaluate the health system strengthening effects of the tool for planning, monitoring and reporting of MDA. They plan to examine:
- the functionality of the tool at scale
- ease of integration across different NTD interventions
- data accessibility, accuracy, timeliness, and usefulness.
The team also aims to understand whether the implementation of this tool would enhance government ownership of the data and the NTD programme in general. This research will aid in identifying barriers and opportunities for potential scale up of the tool throughout Nigeria. The team also plans to focus on understanding how the data will be used at different levels of the health system.
The Zambia Neglected Tropical Disease Control Programme’s role in the attainment of Universal Health Coverage in Zambia: an implementation research study.
This study aims to conduct a landscape analysis to better understand the implementation context for the NTD control programme in Zambia. The activities include:
- an assessment of institutional structures, service delivery systems, existing resources/capacity
- mapping gaps, facilitators, and barriers to program implementation
- identifying potential opportunities to introduce innovative approaches for program integration and improvement.
Key informant interviews and focus group discussions with policy makers and NTD program officers will complement an extensive document review. The results of this assessment will be fed into the next National Health Strategic Plan, which expires in 2021.
The influence of stigma on social participation and mental well-being amongst men and women affected/disabled by lymphatic filariasis and leprosy in the districts of Jaunpur and Patna in India
To what extent does stigma affect social participation and mental wellbeing among men and women affected/disabled by lymphatic filariasis or leprosy in Jaunpur in Uttar Pradesh and Patna in Bihar?
Assessing the effectiveness of using the Community Directed Intervention (CDI) approach to improve community ownership of Mass Drug Administration (MDA) for Neglected Tropical Diseases (NTDs) in Malawi
This project intends to assess the effectiveness of using the Community Directed Intervention (CDI) approach as a vehicle for delivery of mass drug administration (MDA) campaigns against targeted NTDs namely, schistosomiasis and soil-transmitted helminths (STH) such as Ascaris lumbricoides (roundworms), Trichuris trichiura (whip worms) and Ancylostoma sp. (hookworms) in selected districts of Malawi. The idea is to take advantage of the logistical setup, organizational strength and high degree of efficiency of the national NTD programme to improve delivery of the current MDA efforts to control selected and highly prioritized NTDs of schistosomiasis and STH and to enhance community ownership of the interventions in selected rural and remote communities by using the CDI approach. The primary research question is: Can the CDI approach be effectively used to deliver MDA to control NTDs at community level in rural Malawian districts?