Deworming programmes of soil-transmitted helminths are generally monitored and evaluated by aggregating drug coverage and infection levels at a district level. However, heterogeneity in drug coverage ...at finer spatial scales means indicators may remain above thresholds for elimination as a public health problem or of transmission in some areas. This paper aims to highlight the misleading information that aggregating data at larger spatial scales can have for programme decision making.
Drug coverage data from the Geshiyaro project were compared at two spatial scales with reference to the World Health Organisation's targets. District (woreda) and village (kebele) level were compared. The association between infection levels and drug coverage was analysed by fitting a weighted least-squares function to the mean intensity of infection (eggs per gram of faeces) against drug coverage.
The data show clearly that when the evaluation of coverage is aggregated to the district level, information on heterogeneity at a finer spatial scale is lost. Infection intensity decreases significantly (p = 0.0023) with increasing drug coverage.
Aggregating data at large spatial scales can result in prematurely ceasing deworming, prompting rapid infection bounce-back. There is a strong need to define context-specific spatial scales for monitoring and evaluating intervention programmes.
This paper documents changes in the prevalence and intensity of soil-transmitted helminth (STH) infections in the Geshiyaro project in the Wolaita zone of Southern Ethiopia.BACKGROUNDThis paper ...documents changes in the prevalence and intensity of soil-transmitted helminth (STH) infections in the Geshiyaro project in the Wolaita zone of Southern Ethiopia.The Geshiyaro project comprises three intervention arms. Arm 1 is subdivided into the Arm 1 pilot (one district) and Arm 1 (four other districts), both receiving integrated community-wide mass drug administration MDA (cMDA) with intensive water, sanitation, and hygiene (WaSH) interventions. Arm 2 involves 18 districts with cMDA interventions plus the existing government-led One WaSH program, while Arm 3 serves as a control with school-based MDA (sMDA) interventions plus the existing government-led One WaSH program in three districts. The study is designed as a cohort investigation over time, with the establishment of longitudinal sentinel sites where infection levels are assessed annually. A total of 45 longitudinal parasitological surveillance sentinel sites are being used across all three intervention arms to monitor STH prevalence and intensity of infection. From each of the 45 sentinel sites, 150 individuals were randomly selected, stratified by age and gender. The t-test and analysis of variance (ANOVA) were employed to compare infection prevalence and intensity across the three study arms over time.METHODSThe Geshiyaro project comprises three intervention arms. Arm 1 is subdivided into the Arm 1 pilot (one district) and Arm 1 (four other districts), both receiving integrated community-wide mass drug administration MDA (cMDA) with intensive water, sanitation, and hygiene (WaSH) interventions. Arm 2 involves 18 districts with cMDA interventions plus the existing government-led One WaSH program, while Arm 3 serves as a control with school-based MDA (sMDA) interventions plus the existing government-led One WaSH program in three districts. The study is designed as a cohort investigation over time, with the establishment of longitudinal sentinel sites where infection levels are assessed annually. A total of 45 longitudinal parasitological surveillance sentinel sites are being used across all three intervention arms to monitor STH prevalence and intensity of infection. From each of the 45 sentinel sites, 150 individuals were randomly selected, stratified by age and gender. The t-test and analysis of variance (ANOVA) were employed to compare infection prevalence and intensity across the three study arms over time.The prevalence of STH decreased significantly from 34.5% (30.6%, 38.5%) in 2019 to 10.6% (8.3%, 13.4%) in 2022/2023 (df = 1, P < 0.0001) in the Arm 1 pilot, from 27.4% (25.2%, 29.7%) in 2020 to 5.5% (4.4%, 6.7%) in 2023 (df = 1, P < 0.0001) in Arm 1, from 23% (21.3%, 24.8%) in 2020 to 4.5% (3.7%, 5.3%) in 2023 (df = 1, P < 0.001) in Arm 2, and from 49.6% (47.4%, 51.7%) in 2021 to 26.1% in 2023 (df = 1, P < 0.0001) in Arm 3. The relative reduction in the prevalence of any STH was the highest in the arms employing cMDA, namely Arm 2, with a decrease of 82.5% (79.3%, 84.2%), followed by Arm 1 with a reduction of 80.1% (75.3%, 84.6%), and then the Arm 1 pilot with a decrease of 69.4% (60.1%. 76.6%). Arm 3 employing sMDA had the lowest decrease, with a reduction of 46.9% (43.6%, 51%). The mean intensity of infection (based on Kato-Katz egg count measures) for Ascaris lumbricoides species, which was the dominant STH species present in the study area, decreased significantly in Arms 1 and 2, but only slightly in Arm 3. The prevalence of hookworm and Trichuris trichiura infections were found to be very low in all arms but also decreased significantly.RESULTSThe prevalence of STH decreased significantly from 34.5% (30.6%, 38.5%) in 2019 to 10.6% (8.3%, 13.4%) in 2022/2023 (df = 1, P < 0.0001) in the Arm 1 pilot, from 27.4% (25.2%, 29.7%) in 2020 to 5.5% (4.4%, 6.7%) in 2023 (df = 1, P < 0.0001) in Arm 1, from 23% (21.3%, 24.8%) in 2020 to 4.5% (3.7%, 5.3%) in 2023 (df = 1, P < 0.001) in Arm 2, and from 49.6% (47.4%, 51.7%) in 2021 to 26.1% in 2023 (df = 1, P < 0.0001) in Arm 3. The relative reduction in the prevalence of any STH was the highest in the arms employing cMDA, namely Arm 2, with a decrease of 82.5% (79.3%, 84.2%), followed by Arm 1 with a reduction of 80.1% (75.3%, 84.6%), and then the Arm 1 pilot with a decrease of 69.4% (60.1%. 76.6%). Arm 3 employing sMDA had the lowest decrease, with a reduction of 46.9% (43.6%, 51%). The mean intensity of infection (based on Kato-Katz egg count measures) for Ascaris lumbricoides species, which was the dominant STH species present in the study area, decreased significantly in Arms 1 and 2, but only slightly in Arm 3. The prevalence of hookworm and Trichuris trichiura infections were found to be very low in all arms but also decreased significantly.The reduction in the prevalence and intensity of STH in Arms 1 and 2 revealed steady progress towards transmission interruption based on cMDA intervention, but additional efforts with MDA coverage and WaSH interventions are needed to achieve a prevalence threshold < 2% based on the quantitative polymerase chain reaction (qPCR) diagnostic method.CONCLUSIONSThe reduction in the prevalence and intensity of STH in Arms 1 and 2 revealed steady progress towards transmission interruption based on cMDA intervention, but additional efforts with MDA coverage and WaSH interventions are needed to achieve a prevalence threshold < 2% based on the quantitative polymerase chain reaction (qPCR) diagnostic method.
This paper describes changes in the prevalence and intensity of schistosome parasite infections in a project integrating mass drug administration (MDA), water, sanitation, and hygiene (WaSH), and ...behavioral change interventions.
The Geshiyaro Project comprises three intervention arms. Arm 1 is subdivided into "Arm 1 pilot" (one district) and Arm 1 (four other districts), both receiving integrated community-wide MDA with intensive WaSH interventions. Arm 2 involves 17 districts with community-wide MDA interventions, while Arm 3 serves as a control with school-based MDA interventions in three districts. A total of 150 individuals, stratified by age group, were randomly selected from each of the 45 sentinel sites. Arm sizes were 584 (Arm 1 pilot), 1636 (Arm 1), 2203 (Arm 2), and 2238 (Arm 3). Statistical tests were employed to compare infection prevalence and intensity across the different arms.
The prevalence of schistosome parasite infection ranged from 0% to 2.6% and from 1.7% to 25.7% across districts, employing the Kato-Katz (KK) and point-of-care circulating cathodic antigen (POC-CCA) diagnostics, respectively. The mean infection intensity level showed no marked difference between baseline and follow-up surveys when measured by KK, except in Arm 2 (t = 6.89, P < 0.0001). Infection prevalence decreased significantly in Arm 1 (t = 8.62, P < 0.0001), Arm 2 (t = 6.94, P < 0.0001), and Arm 3 (t = 8.83, P < 0.0001), but not in Arm 1 pilot (t = 1.69, P = 0.09) by POC-CCA, when trace was considered positive. The decrease was significant only in Arm 1 (t = 3.28, P = 0.0001) and Arm 2 (t = 7.62, P < 0.0001) when the trace was considered negative in POC-CCA. Arm 2 demonstrated a significant difference in difference (DID) compared to the control group, Arm 3, regardless of whether trace in POC-CCA was considered positive (DID = 3.9%, df = 8780, P = 0.025) or negative (DID = -5.2, df = 8780, P = 0.0004).
The prevalence of schistosomiasis was low when employing the KK diagnostic but moderate in some locations by the POC-CCA diagnostic. The infection level had decreased across all arms of the Geshiyaro study at mid-term of the 7-year project, but further efforts are needed to reduce the rate of parasite transmission based on the POC-CCA diagnostic scores.
Mass drug administration (MDA), targeted at school-aged children (SAC) is recommended by the World Health Organization for the control of morbidity induced by soil-transmitted helminth (STH) ...infection in endemic countries. However, MDA does not prevent reinfection between treatment rounds, and research suggests that only treating SAC will not be sufficient to interrupt transmission of STH. In countries with endemic infection, such as Ethiopia, the coverage, community-groups targeted, and rates of reinfection will determine how effective MDA is in suppressing transmission in the long-term. In this paper, individually-linked longitudinal data from three epidemiological STH surveys conducted between November 2018 and November 2020 in the Wolaita region of Ethiopia are analysed to determine how STH prevalence and intensity changes according to individual level treatment data collected over two rounds of MDA. This study demonstrates that while community-wide MDA successfully reduces overall infection intensity across the villages treated, the observed levels of non-compliance to treatment by individuals acts to maintain levels of parasite abundance whereby transmission interruption is not possible at to, despite reasonable levels of MDA coverage in the communities studied (ranging from 65% to 84% of the village populations). This quantifies with substantial data the often-postulated difference between coverage (accepting treatment) and compliance (swallowing of treatment), the latter impacting the former to a previously unquantified level. The paper highlights the need to focus treatment to partially treated, or never treated groups of individuals within existing community wide MDA control activities to interrupt the transmission of STH, and to reduce the basic reproductive number, R.sub.0, of the parasites to less than unity in value.
Abstract Background Treatment as Prevention (TasP) is an effective intervention to prevent the onward transmission of HIV by lowering viral loads in HIV seropositive patients. In view of the high ...rates of new HIV diagnoses globally in young people, the benefits of TasP as a HIV prevention strategy could be immense. However, the intervention is not a straighforward HIV prevention strategy; there are many practical and ethical implications to be considered before it should be universally recommended. We know that HIV-positive young people (aged 16–29 years) have poor condom use, low rates of disclosure, and chaotic drug adherence patterns. How will TasP affect these other HIV prevention behaviours? Such young people who are already on treatment can give an invaluable insight into many elements of TasP that need to be considered before it is universally adopted as a HIV prevention strategy. The purpose of this survey is to determine understanding and perception of TasP by vertically infected HIV-positive young people. Methods 16 young people with HIV infection answered the survey, which was delivered in person or by telephone. Participation was voluntary, and information gained from this survey would affect health education programming at a UK non-governmental organisation working with such youngsters. The survey contained a mixture of multiple-choice and short-answer questions, and was prefaced by a simple definition of TasP. Findings All 16 respondents were HIV positive and aged 18–29 years, 15 (94%) self-identified as black African, 12 (75%) were women, and 12 (75%) were taking antiretroviral drugs. When asked how likely hypothetically they were to choose to take TasP, six (38%) responded very likely, four (25%) likely, one (6%) unlikely, two (13%) very unlikely, and three (19%) unsure. Eight (50%) respondents identified reduction in transmission as the primary benefit of TasP, with five (31%) citing potential for personal health improvements as a benefit. When asked what they perceived to be negative aspects of TasP, six (38%) reported concerns about the daily hassle of taking antiretroviral drugs (such as routine, lifestyle, burden), five (31%) about unnecessary drug side-effects, and four (25%) about the financial value of TasP. Key learning priorities for respondents were basics of TasP, positive and negative aspects of TasP, and health implications of TasP (12 75% respondents each). Interpretation This survey highlights HIV-positive young people's need for information about TasP. We need to assess the acceptability of TasP among such youngsters. The survey was done with a small group who were vertically infected with HIV and living in the UK. This subgroup was selected because it is the demographic that makes up most people of this age group at the third sector (charity) organisation undertaking the survey, and the results were intended to guide future programming of the organisation. The survey was done with a small convenience sample selected at random from people in the target age group. The results provide an insight into the range of understanding and opinions of TasP and are to be used as a guide for further investigation and provision of information, not necessarily as representation of the thoughts or opinions of the whole population. Funding None.
Twenty neglected tropical diseases (NTDs) are currently prioritised by the World Health Organization for eradication, elimination as a public health problem, elimination of transmission or control by ...2030. This issue celebrates progress made since the 2012 London Declaration on NTDs and discusses challenges currently faced to achieve these goals. It comprises 14 contributions spanning NTDs tackled by intensified disease management to those addressed by preventive chemotherapy. Although COVID-19 negatively affected NTD programmes, it also served to spur new multisectoral approaches to strengthen school-based health systems. The issue highlights the needs to improve impact survey design, evaluate new diagnostics, understand the consequences of heterogeneous prevalence and human movement, the potential impact of alternative treatment strategies and the importance of zoonotic transmission. This article is part of the theme issue 'Challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs'.
Based on four years of participatory action research, this case study examines feminist grassroots organizing in response to three gender discrimination lawsuits in an athletic department at a US ...university. Students and community activists formed a multigenerational, multiracial, cross-class coalition to support the plaintiffs and to pressure university officials to remedy other institutional gender inequities. Our organizing efforts revealed that we did not similarly assess the potential of lawsuits to make substantive changes nor did we share a vision of how the university should be restructured to better serve women. Examining the fault-lines in our activism reveals how the articulation of difference fosters new forms of political consciousness that use more expansive understandings of equity than those in legal narratives, and leads to more radical forms of social justice work outside the narrow confines of normative rights-based aspirations. The findings are positioned in the feminist legal studies and feminist activism literature. This research contributes to our understanding of the impact of court cases on feminist political mobilization and sheds light on the contributions diverse groups of women make to the everyday interpretations of law and localized public understandings of gender equality.
Repeated distribution of preventative chemotherapy (PC) by mass drug administration forms the mainstay of transmission control for five of the 20 recognised neglected tropical diseases (NTDs); ...soil-transmitted helminths, schistosomiasis, lymphatic filariasis, onchocerciasis and trachoma. The efficiency of such programmes is reliant upon participants swallowing the offered treatment consistently at each round. This is measured by compliance, defined as the proportion of eligible participants swallowing treatment. Individually linked longitudinal compliance data is important for assessing the potential impact of MDA-based control programmes, yet this accurate monitoring is rarely implemented in those for NTDs. Longitudinal compliance data reported by control programmes globally for the five (PC)-NTDs since 2016 is examined, focusing on key associations of compliance with age and gender. PubMed and Web of Science was searched in January 2022 for articles written in English and Spanish, and the subsequent extraction adhered to PRISMA guidelines. Study title screening was aided by Rayyan, a machine learning software package. Studies were considered for inclusion if primary compliance data was recorded for more than one time point, in a population larger than 100 participants. All data analysis was conducted in R. A total of 89 studies were identified containing compliance data, 57 were longitudinal studies, of which 25 reported individually linked data reported by varying methods. The association of increasing age with the degree of systematic treatment was commonly reported. The review is limited by the paucity of data published on this topic. The varying and overlapping terminologies used to describe coverage (receiving treatment) and compliance (swallowing treatment) is reviewed. Consequently, it is recommended that WHO considers clearly defining the terms for coverage, compliance, and longitudinal compliance which are currently contradictory across their NTD treatment guidelines. This review is registered with PROSPERO (number: CRD42022301991).
ABSTRACT
Background
Current WHO strategies for reaching soil-transmitted helminths (STH) elimination as a public health problem excludes treating certain adult populations in endemic areas, creating ...infection reservoirs that drive ‘bounce back’ of STH infection to pretreatment levels post-mass drug administration (MDA). Predisposition is a widespread, but poorly understood phenomena among helminth infections where individuals are predisposed to reinfection after repeated treatments.
Methods
This analysis uses Geshiyaro project data, an STH control programme exploring transmission interruption by community-wide MDA and enhanced water, sanitation and hygiene during 2019–2023. Parasitological survey data from longitudinal cohorts are analysed using Kendall's Tau-b rank correlation to assess the evidence for predisposition to light or heavy infection between four consecutive rounds of MDA.
Results
Correlation analyses revealed the strongest evidence for predisposition to heavy or light Ascaris lumbricoides infection was between survey 1 and 2 (Tau-b 0.29; p<0.001). Overall patterns were not observed for Trichuris trichiura or hookworm infections, however, some significant and notable correlations were recorded for some stratifications and time points.
Conclusions
Evidence for predisposition in endemic settings in southern Ethiopia with low STH prevalence suggests that more targeted approaches to MDA in those predisposed to infection may be a sensible control strategy if cheap, point of care diagnostics are available.
