The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India.
Department of Global Health, University of Washington, Seattle, Washington, United States of America.
PLoS Negl Trop Dis. 2023 Mar 10;17(3):e0011176. doi: 10.1371/journal.pntd.0011176. eCollection 2023 Mar.
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).
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.
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.
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.
NCT03014167; ClinicalTrials.gov.
世界卫生组织（WHO）的被忽视热带病（NTD）指南建议对受土壤传播性蠕虫（STH）相关疾病影响不成比例的学龄前和学龄儿童进行有针对性的驱虫，以控制 STH 相关疾病。然而，这种策略让许多成年人未得到治疗，社区内的再感染使传播持续存在，即使儿童大规模药物治疗（MDA）覆盖率很高。有证据表明，通过扩大 MDA 范围至社区范围 MDA（cMDA），可能会中断 STH 传播。
本研究采用组织准备情况调查、关键知情人访谈和方案绘图等多方法，在印度的果阿邦、锡金邦和奥里萨邦的政府利益相关者中进行，以评估各州从基于学校的 MDA 过渡到 cMDA 的准备情况，并确定利用其他 NTD 计划（如淋巴丝虫病（LF））的现有基础设施来进行 STH cMDA 的机会。
总的来说，这三个州都表示有非常有利的政策环境、有效的领导结构、充足的物质资源、展示出的技术能力以及开展 STH cMDA 项目所需的充足社区基础设施。调查结果表明，卫生系统高度准备好实施提供 cMDA 所需的人力资源和财政资源。LF 和 STH MDA 平台重叠程度较高的地区，特别是在社区层面，可能最适合过渡。免疫、母婴健康和非传染性疾病控制计划是 cMDA 可能整合的其他计划。各州表示在州一级建立了有效的领导结构，但让地方领导人和社区团体参与被认为是成功实施 cMDA 的关键。移民是估计药物需求和防止可能缺货的一个挑战。
本研究的结果旨在积极支持印度不同实施背景下的政府决策、优先排序和方案规划，以加速将研究结果转化为实践。
NCT03014167；ClinicalTrials.gov。
