Malaria Elimination Initiative, Global Health Group, University of California, (UCSF), 550 16th St, San Francisco, CA, USA.
Global Programs for Research and Training, Malaria Elimination Initiative Namibia, Windhoek, Namibia.
Malar J. 2021 Mar 22;20(1):162. doi: 10.1186/s12936-021-03679-1.
In Namibia, as in many malaria elimination settings, reactive case detection (RACD), or malaria testing and treatment around index cases, is a standard intervention. Reactive focal mass drug administration (rfMDA), or treatment without testing, and reactive focal vector control (RAVC) in the form of indoor residual spraying, are alternative or adjunctive interventions, but there are limited data regarding their community acceptability.
A parent trial aimed to compare the effectiveness of rfMDA versus RACD, RAVC versus no RAVC, and rfMDA + RAVC versus RACD only. To assess acceptability of these interventions, a mixed-methods study was conducted using key informant interviews (KIIs) and focus group discussions (FGDs) in three rounds (pre-trial and in years 1 and 2 of the trial), and an endline survey.
In total, 17 KIIs, 49 FGDs were conducted with 449 people over three annual rounds of qualitative data collection. Pre-trial, community members more accurately predicted the level of community acceptability than key stakeholders. Throughout the trial, key participant motivators included: malaria risk perception, access to free community-based healthcare and IRS, and community education by respectful study teams. RACD or rfMDA were offered to 1372 and 8948 individuals in years 1 and 2, respectively, and refusal rates were low (< 2%). RAVC was offered to few households (n = 72) in year 1. In year 2, RAVC was offered to more households (n = 944) and refusals were < 1%. In the endline survey, 94.3% of 2147 respondents said they would participate in the same intervention again.
Communities found both reactive focal interventions and their combination highly acceptable. Engaging communities and centering and incorporating their perspectives and experiences during design, implementation, and evaluation of this community-based intervention was critical for optimizing study engagement.
在纳米比亚，与许多消除疟疾环境一样，反应性病例检测（RACD），即在指标病例周围进行疟疾检测和治疗，是一种标准干预措施。无检测反应性集中药物治疗（rfMDA），即不检测进行治疗，以及以室内滞留喷洒形式的反应性集中病媒控制（RAVC），是替代或辅助干预措施，但关于其社区可接受性的数据有限。
一项旨在比较 rfMDA 与 RACD、RAVC 与无 RAVC、rfMDA+RAVC 与仅 RACD 效果的对照试验，同时开展了一项混合方法研究，使用关键知情人访谈（KII）和焦点小组讨论（FGD）在三轮（试验前和试验的第 1 年和第 2 年）和一项终线调查中进行。
在三轮定性数据收集的过程中，共进行了 17 次 KII 和 49 次 FGD，涉及 449 人。试验前，社区成员比关键利益攸关方更准确地预测了社区的可接受性水平。在整个试验过程中，主要参与者的动机包括：疟疾风险认知、获得免费社区基本医疗和 IRS，以及尊重研究团队的社区教育。在第 1 年和第 2 年，分别向 1372 人和 8948 人提供了 RACD 或 rfMDA，拒绝率较低（<2%）。在第 1 年，只有少数家庭（n=72）接受了 RAVC。在第 2 年，向更多家庭（n=944）提供了 RAVC，拒绝率<1%。在终线调查中，2147 名受访者中的 94.3%表示他们将再次参与相同的干预措施。
社区认为反应性集中干预及其组合非常可接受。在设计、实施和评估基于社区的干预措施时，让社区参与并以社区为中心，纳入其观点和经验至关重要，这有助于优化研究参与度。
