A multicenter, community-based, mixed methods assessment of the acceptability of a triple drug regimen for elimination of lymphatic filariasis

Abstract

Background Many countries will not reach elimination targets for lymphatic filariasis in 2020 using the two-drug treatment regimen (diethylcarbamazine citrate [DEC] and albendazole [DA]). A cluster-randomized, community-based safety study performed in Fiji, Haiti, India, Indonesia and Papua New Guinea tested the safety and efficacy of a new regimen of ivermectin, DEC and albendazole (IDA). Methodology/Principal findings To assess acceptability of IDA and DA, a mixed methods study was embedded within this community-based safety study. The study objective was to assess the acceptability of IDA versus DA. Community surveys were performed in each country with randomly selected participants (>14 years) from the safety study participant list in both DA and IDA arms. In depth interviews (IDI) and focus group discussions (FGD) assessed acceptability-related themes. In 1919 individuals, distribution of sex, microfilariae (Mf) presence and circulating filarial antigenemia (CFA), adverse events (AE) and age were similar across arms. A composite acceptability score summed the values from nine indicators (range 9–36). The median (22.5) score indicated threshold of acceptability. There was no difference in scores for IDA and DA regimens. Mean acceptability scores across both treatment arms were: Fiji 33.7 (95% CI: 33.1–34.3); Papua New Guinea 32.9 (95% CI: 31.9–33.8); Indonesia 30.6 (95% CI: 29.8–31.3); Haiti 28.6 (95% CI: 27.8–29.4); India 26.8 (95% CI: 25.6–28) (P<0.001). AE, Mf or CFA were not associated with acceptability. Qualitative research (27 FGD; 42 IDI) highlighted professionalism and appreciation for AE support. No major concerns were detected about number of tablets. Increased uptake of LF treatment by individuals who had never complied with MDA was observed. Conclusions/Significance IDA and DA regimens for LF elimination were highly and equally acceptable in individuals participating in the community-based safety study in Fiji, Haiti, India, Indonesia, and Papua New Guinea. Country variation in acceptability was significant. Acceptability of the professionalism of the treatment delivery was highlighted.

Assessing factors influencing communities’ acceptability of mass drug administration for the elimination of lymphatic filariasis in Guyana

“…Across all regions, a total of 1,248 participants were sampled by the Filarial Mapping team. Of these, one participant over 18 years in each household was selected to receive an expanded acceptability questionnaire (n = 451) based on a previously validated tool [ 23 ]. Selection was determined by Random Number Generator [ 36 ] from among household members over 18 years of age who were present at the time of the survey.…”

“…Three subsets of this dataset were used for analyses included in this paper. Our primary analysis dataset of 390 participants included those selected for the expanded acceptability questionnaire who responded to all our covariates of interest, and to at least five out of nine acceptability scoring questions [ 23 ]. Participants with four or fewer missing acceptability scoring questions had minimum values imputed for those questions as a conservative measure.…”

“…Acceptability of DA was measured through a composite acceptability score which summed the values of nine acceptability indicators that were each scored across a four-point scale [ 23 ]. The possible range of acceptability scores were from 9–36, with 22.5 considered as the threshold of acceptability.…”

“…In addition to coverage and compliance, increasingly individuals’ perceptions of the acceptability of interventions for LF elimination (e.g. MDA) are being investigated as an important consideration for their success [ 23 ]. Treatment acceptability is the extent to which people consider an intervention to be appropriate, based on their cognitive or emotional responses to that intervention [ 24 ].…”

“…The purpose of this study was to assess Guyanese community members’ perceptions of the acceptability of MDA in four administrative regions through use of a community-based treatment acceptability assessment survey [ 23 ], embedded within a larger sentinel site survey. While coverage and compliance data are critical indicators of the program’s success, they may not adequately capture individuals’ attitudes towards the intervention or their motivations for participating (or not participating) in MDA.…”