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Wodnik BK, Louis DH, Joseph M, Wilkers LT, Landskroener SD, Desir L, Lemoine JF, Lavery JV. The roles of stakeholder experience and organizational learning in declining mass drug administration coverage for lymphatic filariasis in Port-au-Prince, Haiti: A case study. PLoS Negl Trop Dis 2020; 14:e0008318. [PMID: 32469860 PMCID: PMC7259509 DOI: 10.1371/journal.pntd.0008318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 04/23/2020] [Indexed: 11/22/2022] Open
Abstract
The World Health Organization (WHO) defines an effective round of mass drug administration (MDA) for lymphatic filariasis (LF) as one that reaches at least 65% of the target population. In its first round of MDA in 2011–2012, the National Program to Eliminate LF in Haiti achieved a 79% epidemiological coverage in urban Port-au-Prince. In 2013, coverage dropped below the WHO threshold and has declined year-over-year to a low of 41% in 2017. We conducted a retrospective qualitative case study to identify key factors behind the decline in coverage in Port-au-Prince and ways to address them. Our findings suggest that the main contributors to the decline in MDA coverage appear to be the absence of effective documentation of practices, reporting, analysis, and program quality improvement—i.e., learning mechanisms—within the program’s MDA design and implementation strategy. In addition to their contribution to the program’s failure to meet its coverage targets, these deficits have resulted in a high cost for the MDA campaign in both lost momentum and depleted morale. Through a proposed operating logic model, we explore how the pathway from program inputs to outcomes is influenced by a wide array of mediating factors, which shape potential participants’ experience of MDA and, in turn, influence their reasoning and decisions to take, or not take, the pills. Our model suggests that the decisions and behavior of individuals are a reflection of their overall experience of the program itself, mediated through a host of contextual factors, and not simply the expression of a fixed choice or preference. This holistic approach offers a novel and potentially valuable framing for the planning and evaluation of MDA strategies for LF and other diseases, and may be applicable in a variety of global health programs. In order to eliminate lymphatic filariasis from a region, the World Health Organization recommends a strategy of preventative drugs delivered annually to the population. At least 65% of the population must participate for four to six consecutive years for this approach to be effective. In urban Port-au-Prince, Haiti, the number of people taking the drugs has been declining progressively below the 65% benchmark since 2012. We used a qualitative case study to identify key factors behind the decline in coverage in Port-au-Prince and ways to address them. We found that the lymphatic filariasis elimination program lacks the necessary design and program infrastructure to ensure reliable learning about problems faced by pill distribution teams on the ground, and the improvisations they introduced to address these challenges. The inability to incorporate these lessons into program improvements and refinements resulted in under-performance and contributed to the decline in coverage. Furthermore, the way that people experience the program is strongly influenced by a host of contextual factors, which shape potential participants’ experience of the program and, in turn, influence their reasoning and decisions to take, or not take, the pills.
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Affiliation(s)
- Breanna K. Wodnik
- Hubert Department of Global Health, Rollins School of Public Health, and Center for Ethics, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Didié Hérold Louis
- National Ambulance Center, Ministry of Public Health and Population, Port-au-Prince, Haiti
| | | | - Lee T. Wilkers
- Hubert Department of Global Health, Rollins School of Public Health, and Center for Ethics, Emory University, Atlanta, Georgia, United States of America
| | - Susan D. Landskroener
- Hubert Department of Global Health, Rollins School of Public Health, and Center for Ethics, Emory University, Atlanta, Georgia, United States of America
| | - Luccene Desir
- Hispaniola Health Initiative, The Carter Center, Port-au-Prince, Haiti
| | - Jean Frantz Lemoine
- National Programs for the Elimination of Malaria and Lymphatic Filariasis, Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - James V. Lavery
- Hubert Department of Global Health, Rollins School of Public Health, and Center for Ethics, Emory University, Atlanta, Georgia, United States of America
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Adhikari B, Vincent R, Wong G, Duddy C, Richardson E, Lavery JV, Molyneux S. A realist review of community engagement with health research. Wellcome Open Res 2019; 4:87. [PMID: 31289754 PMCID: PMC6611131 DOI: 10.12688/wellcomeopenres.15298.2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2019] [Indexed: 01/04/2023] Open
Abstract
Introduction: Community engagement is increasingly recognized as a critical aspect of global health. Recent years have seen an expansion of community engagement activities linked to health research, but debates and inconsistencies remain about the aims of different types of engagement, mechanisms underpinning their implementation and impact, and influential contextual factors. Greater commitment to and consistency around community engagement by health research programs, implementers and funders requires a more coherent evidence base. This realist review is designed to improve our understanding of how and why community engagement contributes to intended and unintended outcomes (including research and ethical outcomes) in different contexts. Given the breadth and diversity of the literature on community engagement in health research, the review will initially focus on malaria research in low- and middle-income countries (LMICs) and draw on wider global health literature where needed. Methods and analysis: Community engagement in practice is often a complex set of interventions. We will conduct a realist review - a theory driven approach to evidence synthesis - to provide explanations for how and why community engagement with health research produces the pattern of outcomes observed across different contexts of application. We will consolidate evidence from a range of documents, including qualitative, quantitative and mixed method studies. The review will follow several stages: devising an initial programme theory, searching evidence, selecting appropriate documents, extracting data, synthesizing and refining the programme theory, and reiteration of these steps as needed. Ethics and dissemination: A formal ethics review is not required for this literature review. Findings will be disseminated in a peer reviewed journal, through national and international conferences, and through a set of short briefings tailored for audiences with an interest in community engagement. Outputs and presentations will be informed by and feed into our network of community engagement experts. PROSPERO registration number: CRD42019125687.
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Affiliation(s)
- Bipin Adhikari
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX1 3SY, UK
| | - Robin Vincent
- Robin Vincent Learning and Evaluation Limited, Sheffield, UK
| | - Geoff Wong
- Nuffield Department of Primary Health Care Services, University of Oxford, Oxford, OX2 6GG, UK
| | - Claire Duddy
- Nuffield Department of Primary Health Care Services, University of Oxford, Oxford, OX2 6GG, UK
| | - Emma Richardson
- Centre for Ethical, Social & Cultural Risk, St Michael's Hospital, Toronto, ON M5B 1W8, Canada
| | - James V. Lavery
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, 30322, USA
- Center for Ethics, Emory University, Altanta, Georgia, 30322, USA
| | - Sassy Molyneux
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX1 3SY, UK
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, University of Oxford, Kilifi, 80108, Kenya
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Adhikari B, Vincent R, Wong G, Duddy C, Richardson E, Lavery JV, Molyneux S. A realist review of community engagement with health research. Wellcome Open Res 2019; 4:87. [PMID: 31289754 PMCID: PMC6611131 DOI: 10.12688/wellcomeopenres.15298.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2019] [Indexed: 09/07/2023] Open
Abstract
Introduction: Community engagement is increasingly recognized as a critical aspect of global health. Recent years have seen an expansion of community engagement activities linked to health research, but debates and inconsistencies remain about the aims of different types of engagement, mechanisms underpinning their implementation and impact, and influential contextual factors. Greater commitment to and consistency around community engagement by health research programs, implementers and funders requires a more coherent evidence base. This realist review is designed to improve our understanding of how and why community engagement contributes to intended and unintended outcomes (including research and ethical outcomes) in different contexts. Given the breadth and diversity of the literature on community engagement in health research, the review will initially focus on malaria research in low- and middle-income countries (LMICs) and draw on wider global health literature where needed. Methods and analysis: Community engagement in practice is often a complex set of interventions. We will conduct a realist review - a theory driven approach to evidence synthesis - to provide explanations for how and why community engagement with health research produces the pattern of outcomes observed across different contexts of application. We will consolidate evidence from a range of documents, including qualitative, quantitative and mixed method studies. The review will follow several stages: devising an initial programme theory, searching evidence, selecting appropriate documents, extracting data, synthesizing and refining the programme theory, and reiteration of these steps as needed. Ethics and dissemination: A formal ethics review is not required for this literature review. Findings will be disseminated in a peer reviewed journal, through national and international conferences, and through a set of short briefings tailored for audiences with an interest in community engagement. Outputs and presentations will be informed by and feed into our network of community engagement experts. PROSPERO registration number: CRD42019125687.
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Affiliation(s)
- Bipin Adhikari
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX1 3SY, UK
| | - Robin Vincent
- Robin Vincent Learning and Evaluation Limited, Sheffield, UK
| | - Geoff Wong
- Nuffield Department of Primary Health Care Services, University of Oxford, Oxford, OX2 6GG, UK
| | - Claire Duddy
- Nuffield Department of Primary Health Care Services, University of Oxford, Oxford, OX2 6GG, UK
| | - Emma Richardson
- Centre for Ethical, Social & Cultural Risk, St Michael's Hospital, Toronto, ON M5B 1W8, Canada
| | - James V. Lavery
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, 30322, USA
- Center for Ethics, Emory University, Altanta, Georgia, 30322, USA
| | - Sassy Molyneux
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX1 3SY, UK
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, University of Oxford, Kilifi, 80108, Kenya
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James S, Collins FH, Welkhoff PA, Emerson C, Godfray HCJ, Gottlieb M, Greenwood B, Lindsay SW, Mbogo CM, Okumu FO, Quemada H, Savadogo M, Singh JA, Tountas KH, Touré YT. Pathway to Deployment of Gene Drive Mosquitoes as a Potential Biocontrol Tool for Elimination of Malaria in Sub-Saharan Africa: Recommendations of a Scientific Working Group †. Am J Trop Med Hyg 2018; 98:1-49. [PMID: 29882508 PMCID: PMC5993454 DOI: 10.4269/ajtmh.18-0083] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/04/2018] [Indexed: 12/22/2022] Open
Abstract
Gene drive technology offers the promise for a high-impact, cost-effective, and durable method to control malaria transmission that would make a significant contribution to elimination. Gene drive systems, such as those based on clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR associated protein, have the potential to spread beneficial traits through interbreeding populations of malaria mosquitoes. However, the characteristics of this technology have raised concerns that necessitate careful consideration of the product development pathway. A multidisciplinary working group considered the implications of low-threshold gene drive systems on the development pathway described in the World Health Organization Guidance Framework for testing genetically modified (GM) mosquitoes, focusing on reduction of malaria transmission by Anopheles gambiae s.l. mosquitoes in Africa as a case study. The group developed recommendations for the safe and ethical testing of gene drive mosquitoes, drawing on prior experience with other vector control tools, GM organisms, and biocontrol agents. These recommendations are organized according to a testing plan that seeks to maximize safety by incrementally increasing the degree of human and environmental exposure to the investigational product. As with biocontrol agents, emphasis is placed on safety evaluation at the end of physically confined laboratory testing as a major decision point for whether to enter field testing. Progression through the testing pathway is based on fulfillment of safety and efficacy criteria, and is subject to regulatory and ethical approvals, as well as social acceptance. The working group identified several resources that were considered important to support responsible field testing of gene drive mosquitoes.
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Affiliation(s)
- Stephanie James
- Foundation for the National Institutes of Health, Bethesda, Maryland
| | | | | | | | | | - Michael Gottlieb
- Foundation for the National Institutes of Health, Bethesda, Maryland
| | - Brian Greenwood
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Fredros O. Okumu
- Ifakara Health Institute, Ifakara, Tanzania
- University of Glasgow, Glasgow, Scotland
- University of the Witwatersrand, Johannesburg, South Africa
| | - Hector Quemada
- Donald Danforth Plant Science Center, Saint Louis, Missouri
| | - Moussa Savadogo
- New Partnership for Africa’s Development, Ouagadougou, Burkina Faso
| | - Jerome A. Singh
- Centre for the AIDS Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
| | - Karen H. Tountas
- Foundation for the National Institutes of Health, Bethesda, Maryland
| | - Yeya T. Touré
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
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