부산대학교 도서관

Background: Soil-transmitted helminth infections (STH) are associated with substantial morbidity in low-and-middle-income countries, accounting for 2.7 million disability-adjusted life years annually. Current World Health Organization guidelines recommend controlling STH-associated morbidity through periodic deworming of at-risk populations, including children and women of reproductive age (15–49 years). However, there is increasing interest in community-wide mass drug administration (cMDA) which includes deworming adults who serve as infection reservoirs as a method to improve coverage and possibly to interrupt STH transmission. We investigated determinants of cMDA coverage by comparing high-coverage clusters (HCCs) and low-coverage clusters (LCCs) receiving STH cMDA in three countries. Methods: A convergent mixed-methods design was used to analyze data from HCCs and LCCs in DeWorm3 trial sites in Benin, India, and Malawi following three rounds of cMDA. Qualitative data were collected via 48 community-level focus group discussions. Quantitative data were collected via routine activities nested within the DeWorm3 trial, including annual censuses and coverage surveys. The Consolidated Framework for Implementation Research (CFIR) guided coding, theme development and a rating process to determine the influence of each CFIR construct on cMDA coverage. Results: Of 23 CFIR constructs evaluated, we identified 11 constructs that differentiated between HCCs and LCCs, indicating they are potential drivers of coverage. Determinants differentiating HCC and LCC include participant experiences with previous community-wide programs, communities' perceptions of directly observed therapy (DOT), perceptions about the treatment uptake behaviors of neighbors, and women's agency to make household-level treatment decisions. Conclusion: The convergent mixed-methods study identified barriers and facilitators that may be useful to NTD programs to improve cMDA implementation for STH, increase treatment coverage, and contribute to the successful control or elimination of STH. Trial registration: The parent trial was registered at clinicaltrials.gov (NCT03014167). Author summary: Soil-transmitted helminths (STH) are a group of three parasitic worms that infect humans through transmission of contaminated soil. An estimated 1.5 billion people world wide are infected, with the highest prevalence reported in sub-Saharan Africa, Asia, and South America. STH may cause gastro-intestinal morbidity that is known to be associated with malnutrition in children and accounts for 2.7 million disability-adjusted life years annually. The World Health Organization strategy is to control morbidity through the periodic treatment of albendazole or mebendazole of at-risk people in endemic areas, namely pre-school and school-aged children, women of reproductive age, and adults in certain occupations that pose a high-risk for transmission. Adult populations not treated may continue to act as reservoirs for STH. Modeling studies have shown that transmission of STH may be interrupted through implementation of community-wide MDA (cMDA) that targets at-risk and adult populations. Studies on cMDA for STH to assess morbidity or elimination are limited. This is a mixed-methods implementation science analysis on implementation of the DeWorm3 community cluster randomized controlled trial that aims to determine the feasibility of interrupting STH in Benin, India, and Malawi. Qualitative focus group discussions and quantitative analysis of census and coverage survey data aims to identify barriers and facilitators to implementing cMDA and compares results between high- and low-coverage clusters across the three countries. The findings may support the development of STH program guidelines and delivery strategies. [ABSTRACT FROM AUTHOR]