Castillo-Neyra Ricardo, Ortiz-Cam Lizzie, Cañari-Casaño Jorge L, Diaz Elvis W, Tamayo Laura D, Porras Guillermo, Recuenco Sergio E, Paz-Soldan Valerie A
Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
medRxiv. 2025 Feb 6:2025.02.05.25321168. doi: 10.1101/2025.02.05.25321168.
Dog-mediated human rabies has been greatly reduced in the Americas and eliminated from most high-income countries. However, many countries in Africa, Asia, and parts of Latin America are still struggling with this gruesome disease. Mass dog vaccination, a One Health strategy, is the primary approach for elimination. However, achieving and sustaining appropriate vaccination coverage in endemic areas remains a challenge. Our objective was to apply the Consolidated Framework for Implementation Research (CFIR) in Arequipa, Peru as a guiding tool to understand the barriers faced by different stakeholders.
Seven focus groups with 56 participants were conducted to capture community perspectives on rabies and vaccination. A workshop was conducted with two groups of public health personnel (n= 69): mass dog vaccination campaign (MDVC) implementers and authorities, in charge of dog rabies control. With these stakeholders we explored factors contributing to the decrease in MDVC post COVID-19. We used the CFIR approach to understand barriers within five different domains: innovation, outer setting, inner setting, individuals, and implementation.
Barriers within the community included insufficient communication, a short vaccination schedule, and fragmented collaboration between system coordinators. At the individual level, a decreased perception of rabies risk occurred as both people and their dogs spent more time indoors due to the COVID-19 pandemic (in urban areas). Dog vaccination was deprioritized compared to COVID protection, with individuals focusing on their own vaccinations and avoiding crowded spaces. In peri-urban areas, longer work hours due to the pandemic's financial impact left less time for dog vaccinations on weekends. Participants reported confusion caused by private veterinarians, who claimed that government-subsidized vaccines were of poor quality. Among implementers and authorities, the main barriers included insufficient MDVC materials and equipment, unclear responsibilities, and a lack of time to evaluate the campaign after activities. Importantly, financial constraints and fragmented commitment from higher-level institutions posed challenges for proper planning and implementation.
We identified barriers and co-designed strategies to improve MDVC participation including strengthening municipal alliances, virtual and physical publicity for events within districts, adequate training for vaccinators, reinforcing vaccinators to remain in fixed spots, and expanding vaccination campaign hours.
在美洲，犬介导的人类狂犬病已大幅减少，且在大多数高收入国家已被消除。然而，非洲、亚洲的许多国家以及拉丁美洲的部分地区仍在与这种可怕的疾病作斗争。大规模犬类疫苗接种作为一种“同一健康”战略，是消除狂犬病的主要方法。然而，在流行地区实现并维持适当的疫苗接种覆盖率仍然是一项挑战。我们的目标是在秘鲁阿雷基帕应用实施研究综合框架（CFIR）作为指导工具，以了解不同利益相关者所面临的障碍。
开展了7个焦点小组讨论，共有56名参与者，以了解社区对狂犬病和疫苗接种的看法。与两组公共卫生人员（n = 69）举办了一次研讨会：大规模犬类疫苗接种运动（MDVC）实施者和负责犬狂犬病控制的当局。与这些利益相关者一起，我们探讨了导致COVID-19后MDVC减少的因素。我们使用CFIR方法来了解五个不同领域内的障碍：创新、外部环境、内部环境、个人和实施。
社区内部的障碍包括沟通不足、疫苗接种时间表短以及系统协调员之间的协作分散。在个人层面，由于COVID-19大流行（在城市地区），人和他们的狗在室内呆的时间更多，因此对狂犬病风险的认知降低。与COVID防护相比，犬类疫苗接种的优先级降低，个人专注于自身疫苗接种并避免拥挤空间。在城郊地区，由于大流行的经济影响导致工作时间延长，使得周末用于犬类疫苗接种的时间减少。参与者报告称，私人兽医造成了混乱，他们声称政府补贴的疫苗质量很差。在实施者和当局中，主要障碍包括MDVC材料和设备不足、责任不明确以及活动后缺乏评估活动的时间。重要的是，财政限制和上级机构的承诺分散对适当的规划和实施构成了挑战。
我们确定了障碍并共同设计了提高MDVC参与度的策略，包括加强市政联盟、在各地区对活动进行虚拟和实体宣传、为接种人员提供充分培训、加强接种人员留在固定地点以及延长疫苗接种运动时间。
