03543nas a2200373   4500000000100000008004100001260004400042653005700086653001800143653002800161653001700189100001100206700001300217700001200230700001200242700001500254700001800269700001500287700001200302700001500314700001900329700001200348700001400360700001700374700001700391700001200408700001400420700001300434245015900447856009800606490000600704520244500710022001403155       2022                            d  bSpringer Science and Business Media LLC10aPublic Health, Environmental and Occupational Health10aHealth Policy10aHealth (social science)10aEpidemiology1 aRoll A1 aSaxena M1 aOrlan E1 aTitus A1 aJuvekar SK1 aGwayi-Chore M1 aAvokpaho E1 aChabi F1 aTogbevi CI1 aBelou Elijan A1 aNindi P1 aWalson JL1 aAjjampur SSR1 aIbikounlé M1 aKalua K1 aAruldas K1 aMeans AR00aPolicy stakeholder perspectives on barriers and facilitators to launching a community-wide mass drug administration program for soil-transmitted helminths  uhttps://ghrp.biomedcentral.com/counter/pdf/10.1186/s41256-022-00281-z.pdf?pdf=button%20sticky0 v73 a<p>Background: Recent evidence suggests that soil-transmitted helminth (STH) transmission interruption may be feasible through community-wide mass drug administration (cMDA) that deworms community members of all ages. A change from school-based deworming to cMDA will require reconfiguring of STH programs in endemic countries. We conducted formative qualitative research in Benin, India, and Malawi to identify barriers and facilitators to successfully launching a cMDA program from the policy-stakeholder perspective.</p>

<p>Methods: We conducted 40 key informant interviews with policy stakeholders identified as critical change agents at national, state/district, and sub-district levels. Participants included World Health Organization country office staff, implementing partners, and national and sub-national government officials. We used the Consolidated Framework for Implementation Research to guide data collection, coding, and analysis. Heat maps were used to organize coded data and differentiate perceived facilitators and barriers to launching cMDA by stakeholder.</p>

<p>Results: Key facilitators to launching a cMDA program included availability of high-quality, tailored sensitization materials, and human and material resources that could be leveraged from previous MDA campaigns. Key barriers included the potential to overburden existing health workers, uncertainty of external funding to sustain a cMDA program, and concerns about weak intragovernmental coordination to implement cMDA. Cross-cutting themes included the need for rigorous trial evidence on STH transmission interruption to gain confidence in cMDA, and implementation evidence to effectively operationalize cMDA. Importantly, if policy stakeholders anticipate a cMDA program cannot be sustained due to cost and human resource barriers in the long term they may be less likely to support the launch of a program in the short term.</p>

<p>Conclusions: Overall, policy stakeholders were optimistic about implementing cMDA primarily because they believe that the tools necessary to successfully implement cMDA are already available. Policy stakeholders in this study were cautiously optimistic about launching cMDA to achieve STH transmission interruption and believe that it is feasible to implement. However, launching cMDA as an alternative policy to school-based deworming will require addressing key resource and evidence barriers.&nbsp;</p>
  a2397-0642