Implementer and recipient perspectives of community-wide mass drug administration for soil-transmitted helminths in Kwale County, Kenya

Soil-transmitted helminthiases (STH) are one of 17 neglected tropical diseases (NTDs) earmarked for control or elimination by 2020 in the WHO’s Roadmap on NTDs. Deworming programs for STH have thus far been focused on treating pre-school and school-aged children; however, there is a growing consensus that to achieve elimination of STH transmission, programs must also target adults, potentially through community-wide mass drug administration (MDA). There is currently a gap in the literature on what components are required to deliver community-wide MDA for STH in order to achieve high intervention reach and uptake. Nested within the TUMIKIA Project, a cluster randomized trial in Kenya evaluating the effectiveness of school-based deworming versus community-wide MDA, we collected qualitative data from program implementers and recipients in eight clusters where community-wide MDA was delivered. Data collection included semi-structured in-depth interviews (n = 72) and focus group discussions (n = 32). A conceptual framework for drug distribution was constructed to help build an analysis codebook. Case memos were developed for each top-level theme. Community-wide MDA for STH was perceived as a complex intervention with key administrative and social mobilization domains. Key actionable themes included: (1) developing an efficient strategy to allocate reasonable workload for implementers to cover all targeted households; (2) maximizing community drug distributors’ motivation through promoting belief in the effectiveness of the intervention and providing sufficient financial incentives; (3) developing effective capacity building strategies for implementers; and (4) implementing a context-adapted community engagement strategy that leverages existing community structures and takes into consideration past community experiences of MDAs. Transitioning from STH control to elimination goals requires significant planning and action to ensure community-wide MDA is delivered with sufficient reach and uptake. We present findings that can inform national deworming programs to increase intervention delivery capacity.Author summary: Infections by soil-transmitted worms are common in tropical and subtropical areas. Control strategies usually involve distributing deworming drugs to children, who are most affected. However, recent evidence suggests that distributing these drugs to whole communities, including adults, might help to achieve the elimination of these worms as a public health problem. As part of a large trial in Kenya evaluating the distribution of deworming drugs to communities, we conducted a qualitative study to explore the perspectives of drug delivery among drug distributors and recipient communities. We conducted and analyzed in-depth interviews and focus group discussions. For community deworming to be implemented well, it requires distributors to be highly motivated and follow a plan that fits well with the characteristics of the target community. In order to accept the deworming drugs, communities need to know about the health problem and the intervention, and trust the delivery system. These findings should prove useful to national deworming programs planning to distribute drugs to whole communities when developing their delivery strategies.