“…Key parameters include the dominant species of STH in each setting; the pre-MDA transmission intensity (R 0 ) for the dominant species; the age profile of infection; effective coverage of MDA, a combination of coverage, compliance, and drug efficacy; and immigration of new hosts and parasites into the community being treated [31,34, ] and highlight the need for more consistent definitions and longitudinal studies of compliance and coverage when MDA is delivered to communities and directly observed therapy may not always be feasible. In addition, systematic nonparticipation in MDA, in which some individuals are less likely to be offered [67,68] or to accept [69,70] MDA -as opposed to random distribution of noncompliance at a given coverage level -is particularly challenging, increasing the predicted number of rounds of MDA required to interrupt transmission even at levels of noncompliance less than 10% [58 & ]. Noncompliance may increase with treatment fatigue in the community, particularly as morbidity, and perceived need for intervention is reduced.…”