03807nas a2200397   4500000000100000008004100001260001200042653002500054653004000079653004100119653003100160100001800191700001400209700001500223700001500238700001600253700001900269700001400288700001200302700001200314700001500326700001400341700001200355700001200367700001700379700001500396700001300411700001300424700001200437245015100449856008800600300000800688490000700696520269200703022001403395       2022                            d  c06/202210aCoincidence analysis10aConfigurational comparative methods10aGlobal health implementation science10aNeglected tropical disease1 aGwayi-Chore M1 aAruldas K1 aAvokpaho E1 aChirambo C1 aKaliappan S1 aHoungbégnon P1 aTogbevi C1 aChabi F1 aNindi P1 aSimwanza J1 aJohnson J1 aMiech E1 aKalua K1 aIbikounlé M1 aAjjampur S1 aWeiner B1 aWalson J1 aMeans A00aDefining optimal implementation packages for delivering community-wide mass drug administration for soil-transmitted helminths with high coverage.  uhttps://bmchealthservres.biomedcentral.com/track/pdf/10.1186/s12913-022-08080-5.pdf  a7920 v223 a<p><strong>BACKGROUND: </strong>Recent evidence suggests that community-wide mass drug administration (MDA) may interrupt the transmission of soil-transmitted helminths (STH), a group of intestinal worms that infect 1.5 billion individuals globally. Although current operational guidelines provide best practices for effective MDA delivery, they do not describe which activities are most essential for achieving high coverage or how they work together to produce effective intervention delivery. We aimed to identify the various packages of influential intervention delivery activities that result in high coverage of community-wide MDA for STH in Benin, India, and Malawi.</p>

<p><strong>METHODS: </strong>We applied coincidence analysis (CNA), a novel cross-case analytical method, to process mapping data as part of the implementation science research of the DeWorm3 Project, a Hybrid Type 1 cluster randomized controlled trial assessing the feasibility of interrupting the transmission of STH using bi-annual community-wide MDA in Benin, India, and Malawi. Our analysis aimed to identify any necessary and/or sufficient combinations of intervention delivery activities (i.e., implementation pathways) that resulted in high MDA coverage. Activities were related to drug supply chain, implementer training, community sensitization strategy, intervention duration, and implementation context. We used pooled implementation data from three sites and six intervention rounds, with study clusters serving as analytical cases (N = 360). Secondary analyses assessed differences in pathways across sites and over intervention rounds.</p>

<p><strong>RESULTS: </strong>Across all three sites and six intervention rounds, efficient duration of MDA delivery (within ten days) singularly emerged as a common and fundamental component for achieving high MDA coverage when combined with other particular activities, including a conducive implementation context, early arrival of albendazole before the planned start of MDA, or a flexible community sensitization strategy. No individual activity proved sufficient by itself for producing high MDA coverage. We observed four possible overall models that could explain effective MDA delivery strategies, all which included efficient duration of MDA delivery as an integral component.</p>

<p><strong>CONCLUSION: </strong>Efficient duration of MDA delivery uniquely stood out as a highly influential implementation activity for producing high coverage of community-wide MDA for STH. Effective MDA delivery can be achieved with flexible implementation strategies that include various combinations of influential intervention components.</p>
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