August 18, 2023
DeWorm3 study publishes new papers, contributing to research on interrupting parasitic worms through community-wide mass drug administration
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The DeWorm3 research team continues to contribute to their body of research on the feasibility of interrupting soil-transmitted helminth (STH) transmission through community-wide mass drug administration (cMDA) in Benin, Malawi and India. Three new publications to highlight include the “Soil-transmitted helminth surveillance in Benin: A mixed-methods analysis of factors influencing non-participation in longitudinal surveillance activities”, the “Overestimation of school-based deworming coverage resulting from school-based reporting” in PLOS Neglected Tropical Diseases and “Policy stakeholder perspectives on barriers and facilitators to launching a community-wide mass drug administration program for soil-transmitted helminths” in the BMC Global Health Research and Policy.
The first publication highlights the influencing factors for non-participants in stool-based STH surveillance activities in Benin. Researchers in Benin found through focus groups that perceived individual-level risks influenced decisions of nonparticipation more strongly than perceptions of community-level benefits. Focus groups also mentioned hesitancy in participation due to rumors about misuse of stool samples and inexperience of collecting stool samples at home. However, participants also shared suggestions to increase participation and decrease the stigma using communication and community engagement strategies. Overall, they found that demographic components like individual’s age, socio-economic status, household religion, household language, consenter’s education, household toilet type, time in current residence, place of main residence, population density, village population size, and baseline cluster STH prevalence were significant factors in participants of STH surveillance. Finally, populations like adults, individuals in urban areas, short-term residents in communities, and those perceiving their families to not be at risk for STH were more likely to refuse participation in stool-based surveillance. (Murphy et al, 2023).
As the DeWorm3 trial is looking into the feasibility of interrupting STH transmission with community-wide MDA rather than the current stand of care of school-based deworming (SBD), an analysis was conducted using DeWorm3 data to quantify discrepancies between school-level reporting of SBD and gold standard individual-level survey reporting of SBD. It was found that, across all 3 sites, that earlier SBD coverage estimates are substantially overestimated and in reality far fewer children were treated as part of SBD programs. There was a 18.6% difference in coverage estimate and the true coverage in Benin, 13.2% difference in India, and 4% difference in Malawi (Sheahan et al, 2023)
The third publication focused on Policy stakeholder perspectives on barriers and facilitators to launching a cMDA program STH. Through key informant interviews with policy stakeholders at the national, state/district, and sub-district level, they found that overall policy stakeholders are optimistic about implementing cMDA to achieve STH transmission interruption and believe that it is feasible to implement. However, they highlighted that launching cMDA as an alternative policy to school-based deworming will require addressing key resource and evidence barriers. The policy stakeholders identified key facilitators in launching cMDA programs and highlighted the use of effective sensitization materials that can be tailored to different geography, education, socioeconomic, cultural and religious groups within a country. They also highlighted that the use of or integrating cMDA into the existing health campaigning materials and programs from the Ministries of Health would facilitate a successful program. The use of existing infrastructure would mitigate costs of building a new program and it may yield higher acceptability rates from community members. The policy stakeholders also noted some key barriers such as concern of overburdening the health workers or community drug distributors who are often overworked and underpaid. They also highlighted sustainability, and funding to be a barrier for a new cMDA program. The policy stakeholders also noted a need for formal intragovernmental partnerships to launch cMDA programs. Lastly, they urge for rigorous evidence from clinical trial and cost-effectiveness data to inform potential updates to STH policy (Roll et al, 2022).
The DeWorm3 study is entering its final year of the trial. All site activities, including the endline cross-sectional survey (CSS3) and endline stool collection, were finalized by March 2023. All three sites were successful in their endline collections and over 100,000 endline samples are currently being tested using qPCR for STH at Christian Medical College (CMC) in Vellore, India and Quantigen, LLC in the US. A smaller subset of samples are also being tested at L’institut de Recherche Clinique du Bénin (IRCB). We expect to finish sample testing by early 2024 at which point final analysis will be conducted to determine if STH transmission has been interrupted. During this time, the DeWorm3 team continues to test samples, clean and analyze data for manuscripts and prepare for the dissemination of final trial results in 2024.
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