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Acceptability and feasibility of tests for infection, serological testing, and photography to define need for
Kristen K Renneker1,2, Tara B Mtuy1,3, George Kabona4
1Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Insights
Community members and health practitioners find new trachoma diagnostic indicators acceptable. Addressing feasibility concerns and providing education are crucial for integrating these tools into trachoma control programs.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Public Health
Background:
- Trachoma, a leading cause of preventable blindness, is caused by Chlamydia trachomatis (Ct) infection.
- Programmatic estimation of trachoma transmission relies on identifying the clinical sign trachomatous inflammation-follicular (TF) in children.
- Complementary indicators for TF, including conjunctival photography and diagnostic tests for ocular Ct infection, require stakeholder acceptability assessment.
Purpose of the Study:
- To assess the perceived acceptability and feasibility of complementary diagnostic indicators for trachoma programs among diverse stakeholders.
- To identify barriers and facilitators for the implementation of novel trachoma diagnostic tools.
Main Methods:
- Qualitative data collection through focus group discussions (FGDs) with community members and in-depth interviews (IDIs) with public health practitioners in Tanzania.
- Quantitative data collection via an online survey distributed to global stakeholders, assessing acceptability and feasibility of diagnostic indicators.
- Content analysis of qualitative data and statistical analysis of survey responses.
Main Results:
- Community members generally found all proposed diagnostic methods acceptable, prioritizing minimal discomfort and accuracy.
- Health practitioners emphasized the need for community education regarding specific sample types.
- Survey results indicated higher agreement on feasibility barriers compared to acceptability issues across all diagnostic indicators.
Conclusions:
- All evaluated diagnostic indicators demonstrated general acceptability among Tanzanian stakeholders.
- Successful integration of these indicators into trachoma programs hinges on addressing feasibility challenges and enhancing community education on their benefits and risks.
Background:
Trachoma causes blindness due to repeated conjunctival infection by Chlamydia trachomatis (Ct). Transmission intensity is estimated, for programmatic decision-making, by prevalence of the clinical sign trachomatous inflammation-follicular (TF) in children aged 1-9 years. Research into complementary indicators to field-graded TF includes work on conjunctival photography, tests for ocular Ct infection, and serology. The perceived acceptability and feasibility of these indicators among a variety of stakeholders is unknown.
Methodology:
Focus group discussions (FGDs) with community members and in-depth interviews (IDIs) with public health practitioners in Tanzania were conducted. FGDs explored themes including participants' experience with, and thoughts about, different diagnostic approaches. The framework method for content analysis was used. IDIs yielded lists of perceived strengths of, and barriers to, implementation for programmatic use of each indicator. These were used to form an online quantitative survey on complementary indicators distributed to global stakeholders via meetings, mailing lists, and social media posts.
Results:
Sixteen FGDs and 11 IDIs were conducted in October-November 2022. In general, all proposed sample methods were deemed acceptable by community members. Common themes included not wanting undue discomfort and a preference for tests perceived as accurate. Health workers noted the importance of community education for some sample types. The online survey was conducted in April-May 2023 with 98 starting the questionnaire and 81 completing it. Regarding barriers to implementing diagnostics, the highest agreement items related to feasibility, rather than acceptability. No evidence of significant differences was found in responses pertaining to community acceptability based on participant characteristics.
Conclusions:
All of the indicators included were generally deemed acceptable by all stakeholders in Tanzania, although community education around the benefits and risks of different sample types, as well as addressing issues around feasibility, will be key to successful, sustainable integration of these indicators into trachoma programs.
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