Evaluation of opportunities to implement community-wide mass drug administration for interrupting transmission of soil-transmitted helminths infections in India

PLOS Neglected Tropical Diseases · 20 authors, 6 centres

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TL;DR

This multi-methods study assessed the readiness of three Indian states to transition from school-based to community-wide mass drug administration for soil-transmitted helminths. It found high readiness in policy and infrastructure but identified human and financial resource gaps as key limitations.

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BACKGROUND

Soil-transmitted helminths (STH) cause significant morbidity in India, with WHO recommending targeted deworming, but community-wide mass drug administration (cMDA) may interrupt transmission. Methods: A multi-methods study with government stakeholders in Goa, Sikkim, and Odisha used organizational readiness surveys, key informant interviews, and program mapping to assess readiness for transitioning to cMDA. Key Results: All states indicated high readiness in policy environment, leadership structure, material resources, technical capacity, and community infrastructure, with median readiness scores often 4-5. However, human resources and financial resources were inadequate, with median scores as low as 1-2. Opportunities to leverage lymphatic filariasis infrastructure were identified, but challenges included in-migration, community resistance, and supply chain issues. Limitations: The study had a small sample size of state-level stakeholders (15-17 per state), and findings may not generalize to all Indian states. Implications: Findings support government decision-making for implementing cMDA, emphasizing the need for investments in human and financial resources and integration with existing programs to address STH transmission.

STUDY TYPE

other

SPECIALTY

public health

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ORIGINAL PAPER

PMC10004831

Evaluation of opportunities to implement community-wide mass drug administration for interrupting transmission of soil-transmitted helminths infections in India

PLOS Neglected Tropical Diseases

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ABSTRACT

Abstract Background The World Health Organization Neglected Tropical Disease (NTD) guidelines recommend control of soil transmitted helminth (STH)-associated morbidity with targeted deworming of preschool and school-aged children who are disproportionately affected by STH-associated morbidity. However, this strategy leaves many adults untreated and reinfection within communities perpetuates transmission even when mass drug administration (MDA) coverage of children is high. Evidence suggests that it may be possible to interrupt STH transmission by expanding MDA to a community-wide MDA (cMDA). Methods This multi-methods study of organizational readiness survey, key informant interviews, and program mapping, were conducted with government stakeholders in three Indian states, Goa, Sikkim, and Odisha, to assess readiness of the states for transitioning from school-based MDA to cMDA and identify opportunities to leverage existing infrastructure from other NTD programs like lymphatic filariasis (LF) for STH cMDA. Principal findings Overall, all three states indicated a highly favorable policy environment, effective leadership structure, adequate material resources, demonstrated technical capacity, and adequate community infrastructure needed to launch a STH cMDA program. The findings indicated a high-level of health system readiness to implement provided human resources and financial resources to deliver cMDA is strengthened. Areas with a significant overlap between LF and STH MDA platforms, particularly at the community-level, may be best primed for transitioning. Immunization, maternal child health, and non-communicable disease control programs were the other programs for possible integration of cMDA. States indicated having effective leadership structures in place at the state-level, however, engaging local leaders and community groups were considered crucial for successful implementation of cMDA. In-migration was a perceived challenge for estimating drug requirement and preventing possible stockouts. Conclusions Findings from this study are intended to proactively support government decision making, prioritization, and program planning across heterogenous implementation contexts in India to speed the translation of research findings into practice. Clinical trial registration NCT03014167 ; ClinicalTrials.gov.

CITATION EXPORT

Kumudha Aruldas, Kim Dawson, Malvika Saxena et al.. Evaluation of opportunities to implement community-wide mass drug administration for interrupting transmission of soil-transmitted helminths infections in India. PLOS Neglected Tropical Diseases. (2023). https://doi.org/10.1371/journal.pntd.0011176

AUTHORS

20 · 6 CENTRES

Kumudha Aruldas, Kim Dawson, Malvika Saxena, Angelin Titus, Jabaselvi Johnson, Marie-Claire Gwayi-Chore, Jayaprakash Muliyil, Gagandeep Kang, Judd L Walson, Ajay Khera, Sitara S R Ajjampur, Arianna Rubin Means, Maria Angeles Gómez-Morales, Eva Clark, Maria Angeles Gómez-Morales, Eva Clark, Maria Angeles Gómez-Morales, Eva Clark, Maria Angeles Gómez-Morales, Eva Clark

1The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
2Department of Global Health, University of Washington, Seattle, Washington, United States of America
3Departments of Global Health, Medicine (Infectious Disease), Pediatrics and Epidemiology, University of Washington, Seattle, Washington, United States of America
4The DeWorm3 Project, University of Washington, Seattle, Washington, United States of America
5Ministry of Health and Family Welfare (former), Government of India, New Delhi, India
6Istituto Superiore di Sanità, ITALY