Innovative Community Referral: Can it improve VL case finding, treatment adherence and success in hard-to-reach settings of northwest Ethiopia?
Research questions: Does an innovative community referral linkage improve VL case finding in hard-to-reach areas of Northwest Ethiopia? Does innovative community referral linkage improve patient adherence to VL treatment? Does innovative community referral linkage improve VL patient’s treatment outcomes? Does an electronic referral linkage system improve back and forth communication and feedback between the treatment centre and community?
The Neglected Mind-Skin Link: Promoting mental health and wellbeing of people affected by skin NTDs: Formative piloting of the WHO Guide on Mental Health and NTD Integration
This study is designed as a proof-of-concept to test the feasibility and acceptability of a proposed intervention package outlined in a soon to be published WHO manual on NTDs and mental health. The primary output of this study is to adapt a model of intervention from the soon to be published WHO guide on Mental Health and NTDs. The team aims to achieve this output through:
- Screening 300 individuals for symptoms of depression and anxiety, refer where necessary, and sample 30 of those individuals for participation in qualitative interviews.
- Conducting peer-led focus group discussions (separate groups for leprosy and LF) to better understand the needs, priorities, and barriers related to affected individuals’ mental wellbeing and quality of life.
- Conducting a workshop with health leaders, community health workers, nurses, service users, family/caregivers, and experts to develop a feasible and applicable theory of change that aligns with WHO guidelines.
- Conducting in depth interviews with key stakeholders to assess the developed model’s feasibility and accessibility Conducting quantitative measures for feasibility and acceptability to assess the stepped-care approach model which involves: improved screening, referral, uptake of service, knowledge uptake following training, and an assessment of whether supervision was carried out. They also plan to triangulate health information data to determine uptake of services.
- Conducting follow-up FGDs with those 30 individuals after a one-month period to understand their experience with primary health center mental health services.
Integrating Preventive Treatment for Female Genital Schistosomiasis within the National Health System: a Pilot Study in Cote d’Ivoire
This study aims to integrate screening and preventive treatment with praziquantel for FGS into routine HIV and reproductive health care visits for women. A pilot study will be conducted in four health facilities with a target sample size of 4800 women over a six-month period. Trainings will be conducted for health workers and the team will use a participatory design process with key stakeholders to ensure that barriers to integration in the health system and community participation are addressed. A scale-up report will be written with stakeholder engagement and all training materials that were developed will be instantly available for use in other clinics in Cote d’Ivoire. Delivery of praziquantel to the four facilities in the pilot study will utilize existing drug-procurement and delivery systems to ensure sustainability.
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.
Female Genital Schistosomiasis in rural Madagascar: improving community understanding and promoting integration into primary health care services- FIRM-UP
The study will take place in the context of a larger clinical trial (FIRM-UP) that includes 4000 women affected by schistosomiasis. For the current study, the team will develop the following “work packages” to better understand community awareness of FGS, clinical diagnosis, and how to provide enhanced training:
- Work Package 1: design and implement a community-based awareness campaign, using community surveys, focus group discussions, and in-depth interviews, to determine uptake and acceptability of FGS services. This will be followed with an end-line survey to assess change in the indicators following the campaign.
- Work Package 2: establish a diagnostic package with digital colposcopy (using smartphones to capture images) and on-site microscopy.
- Work Package 3: provide a refresher training for FIRM-UP study workers, organize a colposcopy and digital imaging workshop, and extended training for staff coming from other endemic regions in Madagascar. An open-source learning platform (‘Moodle’) will be developed to exchange training and learning materials.
IMPRESS – Improving access to integrated Morbidity management and disability PREvention Services through Stigma reduction for people with lower limb lymphoedema in Ethiopia: Feasibility and quasi-experimental study (year 2)
- Formative component: What is the capacity of the integrated morbidity management and disability prevention (MMDP) programme to incorporate a stigma reduction intervention for people with lower limb lymphoedema, and what are the barriers and facilitators to this?
- Intervention component: Is the stigma reduction intervention effective in increasing demand and access to services within an integrated MMDP programme for people with lower limb lymphoedema?
Integration of LF morbidity management and disability prevention (MMDP) into community health services: exploring the coverage and equity of community health worker-driven LF MMDP burden assessment and service uptake in Côte d’Ivoire.
This study will test the reliability of community health worker-led (CHW) MMDP burden estimates by having CHWs first estimate MMDP burden, followed by a rigorous population-based survey to get a representative estimate of MMDP burden for the district. Six months later, these cases will be followed up to see whether they accessed the MMDP services and assess the quality of care. The study will examine the accuracy of the CHW estimates, CHWs’ ability to diagnose properly, social biases of health care workers that may prevent equitable care delivery, and the cost comparison of the CHW method vs. population-based survey. In addition, the team plans to conduct an evaluation of the quality of MMDP service provision, including available psychosocial support, at all facilities in the selected health district. Programs need a feasible and reliable method for coming up with MMDP burden estimates for LF and strategies to ensure that people have access to care and utilize that care. This study addresses the two pillars of WHO dossier development for MMDP and will provide the Ministry of Health with essential information to plan and adapt their program to accommodate MMDP services.
Improving Neglected Tropical Disease (NTD) services and integrating into primary health care in Southern Nations, Nationalities, and Peoples' Region (SNNPR), Ethiopia
This study outlines an important first step to understanding NTD program integration in Ethiopia and builds on previous work in SNNPR. The study team plans to carry out significant formative research to better understand what gaps currently exist in the Ethiopian primary health care system that prevent integration of NTD services. They aim to answer the following questions:
- What are the current gaps in the Ethiopian primary health care system for implementing integrated NTD services and how can they be addressed?
- What is the community’s perception and awareness of selected NTDs and how can it be improved?
Following the gap analysis, the study team, along with the ministry of health and NTD taskforce of Ethiopia, will develop interventions to address these gaps. Outputs of the intervention stage are expected to include the following: a detailed description of the intervention, including case definitions, roles and responsibilities at the different levels of the health system, data recording and reporting mechanisms, referral systems; training manuals for the different primary healthcare system levels, job aids, guidance for supportive supervision. The team has made extensive plans to address issues of sustainability and scalability of the project including a cost analysis of the interventions, developing close partnerships with health facilities’ procurement departments, and close engagement during budget planning exercises of district health offices.
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 Impact of an Integrated Health System Approach in Improving Access to Morbidity Management and Disability Prevention Services for Persons with Leprosy, Hydrocele, and Lymphoedema in Coastal Kenya
Formative: To what extent do individuals have quality of life and access to and utilize MMDP services within the healthcare system; and what are the barriers and facilitators (affordability, availability, approachability, acceptability, and appropriateness) of 1) access to and utilization of quality MMDP healthcare services and 2) management of morbidities at home?
Intervention: What is the effect of an integrated health system approach on access to MMDP healthcare services as measured by affordability, accessibility, acceptability, and availability; and on utilization of services and quality of life?