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Randomized Controlled Trial
. 2022 Jun 18;22(1):792.
doi: 10.1186/s12913-022-08080-5.

Defining optimal implementation packages for delivering community-wide mass drug administration for soil-transmitted helminths with high coverage

Marie-Claire Gwayi-Chore  1   2 , Kumudha Aruldas  3 , Euripide Avokpaho  4 , Chawanangwa Maherebe Chirambo  5 , Saravanakumar Puthupalayam Kaliappan  3 , Parfait Houngbégnon  4 , Comlanvi Innocent Togbevi  4 , Félicien Chabi  4 , Providence Nindi  5 , James Simwanza  5 , Jabaselvi Johnson  3 , Edward J Miech  6 , Khumbo Kalua  5   7 , Moudachirou Ibikounlé  4   8 , Sitara S R Ajjampur  3 , Bryan J Weiner  9 , Judd L Walson  9   10   11 , Arianna Rubin Means  9   10
Affiliations
Randomized Controlled Trial

Defining optimal implementation packages for delivering community-wide mass drug administration for soil-transmitted helminths with high coverage

Marie-Claire Gwayi-Chore et al. BMC Health Serv Res. .

Abstract

Background: Recent evidence suggests that community-wide mass drug administration (MDA) may interrupt the transmission of soil-transmitted helminths (STH), a group of intestinal worms that infect 1.5 billion individuals globally. Although current operational guidelines provide best practices for effective MDA delivery, they do not describe which activities are most essential for achieving high coverage or how they work together to produce effective intervention delivery. We aimed to identify the various packages of influential intervention delivery activities that result in high coverage of community-wide MDA for STH in Benin, India, and Malawi.

Methods: We applied coincidence analysis (CNA), a novel cross-case analytical method, to process mapping data as part of the implementation science research of the DeWorm3 Project, a Hybrid Type 1 cluster randomized controlled trial assessing the feasibility of interrupting the transmission of STH using bi-annual community-wide MDA in Benin, India, and Malawi. Our analysis aimed to identify any necessary and/or sufficient combinations of intervention delivery activities (i.e., implementation pathways) that resulted in high MDA coverage. Activities were related to drug supply chain, implementer training, community sensitization strategy, intervention duration, and implementation context. We used pooled implementation data from three sites and six intervention rounds, with study clusters serving as analytical cases (N = 360). Secondary analyses assessed differences in pathways across sites and over intervention rounds.

Results: Across all three sites and six intervention rounds, efficient duration of MDA delivery (within ten days) singularly emerged as a common and fundamental component for achieving high MDA coverage when combined with other particular activities, including a conducive implementation context, early arrival of albendazole before the planned start of MDA, or a flexible community sensitization strategy. No individual activity proved sufficient by itself for producing high MDA coverage. We observed four possible overall models that could explain effective MDA delivery strategies, all which included efficient duration of MDA delivery as an integral component.

Conclusion: Efficient duration of MDA delivery uniquely stood out as a highly influential implementation activity for producing high coverage of community-wide MDA for STH. Effective MDA delivery can be achieved with flexible implementation strategies that include various combinations of influential intervention components.

Keywords: Coincidence analysis; Configurational comparative methods; Global health implementation science; Neglected tropical disease.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Median community-wide MDA coverage rates, by site and intervention round
Fig. 2
Fig. 2
Conditions represented within CNA models for achieving 228 high coverage of community-wide MDA for STH
See this image and copyright information in PMC

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