A Multiphase Implementation of Ring Treatment: A Community-Engaged Control Program for T. Solium...

Background Cysticercosis (CC) is a zoonotic disease transmitted between pigs and humans, caused by the larval stage of T. solium that leads to neurological morbidity in humans and economic losses in pig-farming communities in low-resource rural regions. Ring Treatment (RT) is an evidence-based intervention that integrates a community participatory approach to provide antiparasitic treatment to households within 100-meters of an infected pig. This study aimed to evaluate the multiphase implementation of RT as a public health program in northern Peru, with a focus on feasibility, adoption, and sustainability. Methods We conducted a multi-method, three-phase implementation study from 2019-2025 in Tumbes, Peru. Phase 1 involved a formative evaluation using the expanded Consolidated Framework for Implementation Research for low- and middle-income countries. We used semi-structured interviews (n = 169), social network surveys (n = 341), and two process-mapping workshops (n = 26) to describe barriers, facilitators, and RT protocol adaptations. In phase 2, we piloted RT in a small health district, reviewed registries, and conducted community surveys and interviews for quality improvement. In phase 3, we rolled out RT in two districts and applied the RE-AIM framework to assess implementation outcomes. Quantitative data were analyzed using descriptive statistics, while qualitative data underwent rapid qualitative analysis and template analysis (thematic analysis for hierarchical coding). Results Key facilitators included adaptability of existing health programs and strong engagement with community health workers (CHW) and communities. Barriers included high staff turnover, workload, and resource constraints. The pilot study achieved 75% treatment coverage among eligible populations, increased community knowledge of the CC transmission cycle, and prompted regional-level policy changes. During the RT rollout, 100% of health facilities established RT procedures, with moderate participation in training and treatment (53% and 87%). However, the COVID-19 pandemic and political instability limited the effectiveness of assessments and the completeness of data. Conclusions RT is feasible and acceptable as a public health program for T. solium control in rural, endemic, low-resource settings. Success hinges on community and CHW involvement, adaptive protocols, and cross-sectoral partnerships. Continued investment in One Health approaches that view the human-animal-environment intersection as central to health is needed to sustain and expand progress in controlling zoonoses.