Identifying opportunities to optimize mass drug administration for soil-transmitted helminths: A visualization and...

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Implementation Science

Background:

• Soil-transmitted helminth (STH) control relies on mass drug administration (MDA), primarily targeting children.
• Community-wide MDA (cMDA) shows potential for interrupting STH transmission across all age groups.
• Transitioning to cMDA necessitates adapting existing implementation processes.

Purpose of the Study:

• To describe and compare the implementation processes of school-based MDA and cMDA.
• To identify implementation bottlenecks and areas for improvement in MDA delivery.
• To evaluate the feasibility of using process mapping for MDA program adaptation.

Main Methods:

• Process mapping, an operational research methodology, was used in Benin, India, and Malawi over three years.
• Workshops identified planned activities; maps were updated annually to reflect adaptations and deviations.
• Descriptive and comparative analyses quantified differences between school-based MDA and cMDA implementation.

Main Results:

• cMDA implementation involved an average of 13 additional activities and more frequent adaptations (5.2/year) compared to school-based MDA.
• Approximately 41% of activities across both platforms deviated from planned timelines, often to enhance efficiency or effectiveness.
• Visualized process maps highlighted drug receipt at the local level as a potential bottleneck, emphasizing the importance of timing and drug quantification.

Conclusions:

• MDA implementation is context- and resource-dependent, with multiple viable approaches.
• Process mapping can facilitate the shift from school-based programs to cMDA for STH transmission interruption.
• Process mapping may support the integration of STH control with other community-based health campaigns.