03815nas a2200565   4500000000100000008004100001260004400042653003100086653002900117653001600146653001400162653001300176100001300189700002500202700001600227700001500243700001400258700001500272700001200287700001600299700001900315700001400334700001700348700001400365700001200379700001400391700001700405700001300422700001400435700001400449700001400463700001500477700002200492700001300514700001500527700002000542700001400562700001300576700001200589700001700601700001300618700001700631700001400648245016000662856007300822300000900895490000700904520232400911022001403235       2024                            d  bSpringer Science and Business Media LLC10aSoil-transmitted helminths10aMass drug administration10aAlbendazole10aCommunity10aCoverage1 aMeans AR1 aÁsbjörnsdóttir KH1 aSharrock KC1 aGalagan SR1 aAruldas K1 aAvokpaho E1 aChabi F1 aHalliday KE1 aHoungbégnon P1 aIsrael GJ1 aKaliappan SP1 aKennedy D1 aLegge H1 aOswald WE1 aPalanisamy G1 aRogers E1 aTimothy J1 aPearman E1 aRamesh RM1 aSimwanza J1 aSheik-Abdullah JF1 aSheikh M1 aTogbevi CI1 aWitek-McManus S1 aPullan RL1 aBailey R1 aKalua K1 aIbikounlé M1 aLuty AJF1 aAjjampur SSR1 aWalson JL00aCoverage of community-wide mass drug administration platforms for soil-transmitted helminths in Benin, India, and Malawi: findings from the DeWorm3 project  uhttps://link.springer.com/content/pdf/10.1186/s40249-024-01241-0.pdf  a1-140 v133 a<p><strong>Background: </strong>Soil-transmitted helminths (STH) affect approximately 1.5 billion people globally. The current STH control strategy is annual or twice-annual preventive chemotherapy, typically school-based deworming targeting children and women of reproductive age. Mathematical modeling suggests that it may be possible to interrupt STH transmission through high-coverage community-wide mass drug administration (cMDA). DeWorm3 is a cluster randomized trial testing cMDA for prevalence reduction and transmission interruption. The purpose of this study is to describe coverage of cMDA in study clusters over time and correlates of coverage at individual and cluster levels.</p>

<p><strong>Methods:</strong>&nbsp;From 2018–2020, DeWorm3 delivered six rounds of cMDA with 400&nbsp;mg albendazole at sites in Benin, India, and Malawi. We report coverage, treatment uptake, and directly observed therapy across all rounds. Factors associated with coverage at the cluster level were identified using binomial generalized estimating equations, while factors associated with non-treatment at the individual level were identified using binomial mixed-effects models.</p>

<p><strong>Results:</strong> Coverage was high across all clusters and rounds, exceeding the WHO target of 75% in all sites and across all rounds (78% to 95%); cluster-level coverage tended to increase over time. Younger, unmarried, and migratory adults were more likely to be untreated at all sites; adult males were more likely to be untreated in Benin and Malawi. Among children, girls were more likely to be untreated, as were non-school-attending and migratory children. Higher adult education was associated with greater odds of non-treatment among adults, but lower odds among children in the household. Belonging to a less wealthy or minority language-speaking household was associated with non-treatment among both adults and children.</p>

<p><strong>Conclusions: </strong>It is possible to deliver community-wide MDA with high coverage. Unique individual and community-level factors influence treatment across settings, and these may be addressed through targeted programming. Trial Registration: Field Studies on the Feasibility of Interrupting the Transmission of Soil-transmitted Helminths (STH), NCT03014167.</p>
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