03305nas a2200349   4500000000100000008004100001260000800042653002100050100001500071700001500086700001100101700001200112700001200124700002900136700001900165700001200184700001500196700001400211700001200225700001400237700001700251700001700268700001200285700001400297700001300311245017000324856006600494300001200560490000700572520235100579022002502930       2022                            d  bBMJ10aGeneral Medicine1 aAvokpaho E1 aLawrence S1 aRoll A1 aTitus A1 aJacob Y1 aPuthupalayam Kaliappan S1 aGwayi-Chore MC1 aChabi F1 aTogbevi CI1 aElijan AB1 aNindi P1 aWalson JL1 aAjjampur SSR1 aIbikounlé M1 aKalua K1 aAruldas K1 aMeans AR00aIt depends on how you tell: a qualitative diagnostic analysis of the implementation climate for community-wide mass drug administration for soil-transmitted helminth  uhttps://bmjopen.bmj.com/content/bmjopen/12/6/e061682.full.pdf  ae0616820 v123 a<p>Objectives</p>

<p>Current soil-transmitted helminth (STH) morbidity control guidelines primarily target deworming of preschool and school-age children. Emerging evidence suggests that community-wide mass drug administration (cMDA) may interrupt STH transmission. However, the success of such programmes depends on achieving high treatment coverage and uptake. This formative analysis was conducted to evaluate the implementation climate for cMDA and to determine barriers and facilitators to launch.</p>

<p>Settings</p>

<p>Prior to the launch of a cMDA trial in Benin, India and Malawi.</p>

<p>Participants</p>

<p>Community members (adult women and men, children, and local leaders), community drug distributors (CDDs) and health facility workers.</p>

<p>Design</p>

<p>We conducted 48 focus group discussions (FGDs) with community members, 13 FGDs with CDDs and 5 FGDs with health facility workers in twelve randomly selected clusters across the three study countries. We used the Consolidated Framework for Implementation Research to guide the design of the interview guide and thematic analysis.</p>

<p>Results</p>

<p>Across all three sites, aspects of the implementation climate that were facilitators to cMDA launch included: high community member demand for cMDA, integration of cMDA into existing vaccination campaigns and/or health services, and engagement with familiar health workers. Barriers to launching cMDA included mistrust towards medical interventions, fear of side effects and limited perceived need for interrupting STH transmission. We include specific recommendations from community members regarding cMDA distribution sites, personnel requirements, delivery timing and incentives, leaders to engage and methods for mobilising participants.</p>

<p>Conclusions</p>

<p>Prior to launching the cMDA programme as an alternative to school-based MDA, cMDA was found to be generally acceptable across diverse geographical and demographic settings. Community members, CDDs and health workers felt that engaging communities and tailoring programmes to the local context are critical for success. Potential barriers may be mitigated by identifying local concerns and addressing them via targeted community sensitisation prior to implementation.Trial registration numberNCT03014167; Pre-results.</p>
  a2044-6055, 2044-6055