Re-envisioning the "F" in SAFE: Facial cleanliness and hygiene metrics, personal hygiene practices, and trachoma risk: Operational research for enhanced evaluation
Reliability assessment: What is the intra- and inter-rater reliability of current qualitative F and novel quantitative hygiene metrics across study contexts?
Validity assessment: What is the validity of each metric of interest (i.e., quantitative hygiene and qualitative F metrics) with regard to recent personal hygiene practices and trachoma outcomes?
Utility assessment: What is the utility of each metric (i.e., qualitative and quantitative)?
Risk factor assessment: Do proxy facial and hand hygiene outcomes, as measured by the novel quantitative hygiene metric, represent risk factors of incident C. trachomatis infection?"
Can geostatistical tools be used to develop a stop IDA strategy for LF that can measure <1% Mf prevalence in adults?
To determine the appropriate serologic threshold(s) to be used to initiate MDA for onchocerciasis.
Morbidity management for hard to reach populations in insecure areas in Burkina Faso: analysis of barriers and determination of the resilience of the health system
The study aims to identify the most effective approaches for case management and delivery of surgical services for IDPs and migrants suffering from LF and/or trachoma in security compromised areas. Barriers to reaching morbidity patients will be assessed, in addition to determinants of the institutionalizatoin of NTD morbidity management within the national health system. Research aims will be addressed through the following key activities: document review and direct inspection protocols to determine health facilities' ability to provide MMDP services; active case finding including creation of WhatsApp groups and SMS messaging to help keep track of patients and refer them to care; key informant interviews with health workers and community leaders to assess behavior change communication strategies for raising awareness among affected individuals; one-on-one interviews and focus group discussions with patients to understand barriers to care; and stakeholder engagement to increase buy-in and identify ways to operationalize MMDP services within national program.
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
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.
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