Our desire is to make this village intestinal worm free”: Identifying determinants of high coverage of community-wide mass drug administration for soil transmitted helminths in Benin, India, and Malawi

Abstract

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) andlow-coverage clusters (LCCs) receiving STH cMDA in three countries. Methods Aconvergent mixed-methods design was used to analyze data from HCCsand LCCs in DeWorm3trial 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 andcoverage 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 23CFIRconstructs 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 treat ment uptake behaviors of neighbors, and women’s agency to make household-level treatment decisions. Conclusion Theconvergent mixed-methods study identified barriers and facilitators that may be useful to NTDprograms toimprove cMDAimplementation for STH, increase treatment coverage, andcontribute to the successful control or elimination of STH.