A mixed-method study to improve outcome of mass drug administration in two TAS failed districts of Uttar Pradesh,...

Lymphatic filariasis (LF), commonly called "elephantiasis," is one of the leading causes of disability around the world, with approximately 863 million people across 47 countries still living under threat of LF infection. India, with 40% of the global LF burden, is the most affected country that undertakes annual mass drug administration (MDA) using double and triple drug chemoprophylaxis in 157 LF-endemic districts. Consumption of drugs during MDA campaigns remains the biggest challenge for disease elimination in the country. PATH conducted a dual-phased study titled, "A Mixed-Method Study to Improve outcome of Mass Drug Administration in Two TAS failed Districts of Uttar Pradesh, India." The study aimed to identify the critical factors in achieving optimal drug consumption among community members during MDA campaigns (pre-intervention phase), develop an intervention package (IP) for use in the government's subsequent MDA program to improve the coverage, and assess the impact (post-intervention phase). The quantitative data collection entailed house-to-house and drug administrator surveys, while qualitative data collection included in-depth interviews and rapid ethnography. The main reason for non-consumption was found to be fear of side effects, followed by away from home, lack of awareness, and suboptimal micro-planning. Post-IP measurements showed that there was an increase in evaluated coverage of 10.1% in Varanasi and 20.7% in Chitrakoot, as well as an increase in community awareness of 40% in Chitrakoot, with interpersonal communication being the most effective method for demand generation/ community awareness. An Intervention Package (IP), developed and piloted in the two study districts, was adopted by the state government of Uttar Pradesh and used across all 50 LF-endemic districts in the state.