Optimizing the implementation of case-area targeted interventions during cholera outbreaks with context-specific...

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Global Health Security

Background:

• Cholera is a severe fecal-oral disease disproportionately affecting impoverished communities lacking safe water and sanitation.
• Individuals in close proximity to cholera patients face elevated infection risk, necessitating targeted interventions during outbreaks.

Purpose of the Study:

• To investigate how case-area targeted interventions (CATIs) and similar mechanisms are implemented and adapted in diverse global settings.
• To identify challenges and successful adaptations in cholera outbreak response strategies.

Main Methods:

• A narrative review of 43 peer-reviewed articles and gray literature sources.
• 15 key informant interviews using snowball sampling.
• Analysis of 27 CATI or CATI-like experiences across 15 countries (2004-2024).

Main Results:

• Four delivery mechanisms were identified: CATI, pre-CATI, case-cluster, and health-facility-based interventions (HBI).
• Key implementation challenges included response delays, access difficulties, resource shortages, limited capacity, and coordination issues.
• Adaptations focused on readiness, local capacity building, resource optimization, and case prioritization, especially in high-load or insecure contexts.

Conclusions:

• A practitioner-centered framework was developed to optimize cholera response through context-specific delivery mechanisms.
• Effective implementation and adaptation of CATIs are crucial for decreasing cholera incidence globally.