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Xie S, Rieders M, Changolkar S, Bhattacharya BB, Diaz EW, Levy MZ, Castillo-Neyra R. Enhancing Mass Vaccination Programs with Queueing Theory and Spatial Optimization. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.14.24308958. [PMID: 38947058 PMCID: PMC11213063 DOI: 10.1101/2024.06.14.24308958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Background Mass vaccination is a cornerstone of public health emergency preparedness and response. However, injudicious placement of vaccination sites can lead to the formation of long waiting lines or queues, which discourages individuals from waiting to be vaccinated and may thus jeopardize the achievement of public health targets. Queueing theory offers a framework for modeling queue formation at vaccination sites and its effect on vaccine uptake. Methods We developed an algorithm that integrates queueing theory within a spatial optimization framework to optimize the placement of mass vaccination sites. The algorithm was built and tested using data from a mass canine rabies vaccination campaign in Arequipa, Peru. We compared expected vaccination coverage and losses from queueing (i.e., attrition) for sites optimized with our queue-conscious algorithm to those obtained from a queue-naive version of the same algorithm. Results Sites placed by the queue-conscious algorithm resulted in 9-19% less attrition and 1-2% higher vaccination coverage compared to sites placed by the queue-naïve algorithm. Compared to the queue-naïve algorithm, the queue-conscious algorithm favored placing more sites in densely populated areas to offset high arrival volumes, thereby reducing losses due to excessive queueing. These results were not sensitive to misspecification of queueing parameters or relaxation of the constant arrival rate assumption. Conclusion One should consider losses from queueing to optimally place mass vaccination sites, even when empirically derived queueing parameters are not available. Due to the negative impacts of excessive wait times on participant satisfaction, reducing queueing attrition is also expected to yield downstream benefits and improve vaccination coverage in subsequent mass vaccination campaigns.
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Affiliation(s)
- Sherrie Xie
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Maria Rieders
- Operations, Information and Decisions Department, The Wharton School, University of Pennsylvania
| | - Srisa Changolkar
- Operations, Information and Decisions Department, The Wharton School, University of Pennsylvania
| | | | - Elvis W. Diaz
- Zoonotic Disease Research Lab, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Michael Z. Levy
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
- Zoonotic Disease Research Lab, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ricardo Castillo-Neyra
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
- Zoonotic Disease Research Lab, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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Castillo-Neyra R, Larson AJ, Tamayo LD, Arevalo-Nieto C, Brown J, Condori-Pino C, Ortega E, Levy MZ, Paz-Soldan VA. Perceptions of Problems with Household Insects: Qualitative and Quantitative Findings from Peri-Urban Communities in Arequipa, Peru. Am J Trop Med Hyg 2023; 109:1372-1379. [PMID: 37931314 DOI: 10.4269/ajtmh.23-0266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/19/2023] [Indexed: 11/08/2023] Open
Abstract
Vector-borne diseases continue to impose a major health burden on Peru and neighboring countries. The challenge of addressing vector-borne disease is compounded by changing social, economic, and climatic conditions. Peri-urban Arequipa is an important region to study insect infestations because of ongoing challenges with disease vectors such as triatomines and a variety of other insects. We conducted surveys (N = 1,182) and seven focus groups (average seven participants) in peri-urban Arequipa to explore knowledge of and perception toward various insects that infest the region. Focus group participants reported the presence of a wide variety of insects in and around the home, including disease vectors such as triatomines (also identified by 27.2% of survey households), mosquitoes, spiders, and bed bugs, as well as nuisance insects. Health concerns related to insects included vector-borne diseases, spider bites, allergies, and sequelae from bed bug bites, and hygiene concerns. A majority of participants in the quantitative surveys identified triatomines as the insect they were most worried about (69.9%) and could identify Chagas disease as a health risk associated with triatomines (54.9%). Insect infestations in peri-urban Arequipa present multiple burdens to residents, including injury and illness from triatomines and other insects, as well as potential mental and economic concerns related to insects such as bed bugs. Future initiatives should continue to address triatomine infestations through educational outreach and implement a more holistic approach to address the burden of both disease and nuisance insects.
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Affiliation(s)
- Ricardo Castillo-Neyra
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martín de Porres, Lima, Peru
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anika J Larson
- University of Washington, School of Medicine, Seattle, Washington
| | - Laura D Tamayo
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martín de Porres, Lima, Peru
| | - Claudia Arevalo-Nieto
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martín de Porres, Lima, Peru
| | | | - Carlos Condori-Pino
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martín de Porres, Lima, Peru
| | - Emma Ortega
- Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Michael Z Levy
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martín de Porres, Lima, Peru
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
| | - Valerie A Paz-Soldan
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martín de Porres, Lima, Peru
- Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
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Buttenheim A, Castillo-Neyra R, Arevalo-Nieto C, Shinnick JE, Sheen JK, Volpp K, Paz-Soldan V, Behrman JR, Levy MZ. Do Incentives Crowd Out Motivation? A Feasibility Study of a Community Vector-Control Campaign in Peru. Behav Med 2023; 49:53-61. [PMID: 34847825 PMCID: PMC9869690 DOI: 10.1080/08964289.2021.1977603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 06/20/2021] [Accepted: 08/22/2021] [Indexed: 01/28/2023]
Abstract
Incentives are a useful tool in encouraging healthy behavior as part of public health initiatives. However, there remains concern about motivation crowd out-a decline in levels of motivation to undertake a behavior to below baseline levels after incentives have been removed-and few public health studies have assessed for motivation crowd out. Here, we assess the feasibility of identifying motivation crowd out following a lottery to promote participation in a Chagas disease vector control campaign. We look for evidence of crowd out in subsequent participation in the same behavior, a related behavior, and an unrelated behavior. We identified potential motivation crowd out for the same behavior, but not for related behavior or unrelated behaviors after lottery incentives are removed. Despite some limitations, we conclude that motivation crowd out is feasible to assess in large-scale trials of incentives.
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Affiliation(s)
- Alison Buttenheim
- Department of Family and Community Nursing, University of Pennsylvania, Philadelphia, USA
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, USA
| | - Ricardo Castillo-Neyra
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, USA
- Department of Health Management, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Claudia Arevalo-Nieto
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, USA
- Department of Health Management, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Julianna E. Shinnick
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, USA
| | - Justin K. Sheen
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, USA
| | - Kevin Volpp
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, USA
| | - Valerie Paz-Soldan
- Department of Health Management, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
- Asociasión Benéfica PRISMA, Lima, Peru
| | - Jere R. Behrman
- Departments of Economics and Sociology, University of Pennsylvania, Philadelphia, USA
| | - Michael Z. Levy
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, USA
- Department of Health Management, Universidad Peruana Cayetano Heredia, Lima, Peru
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Nieto-Sanchez C, Hatley DM, Grijalva MJ, Peeters Grietens K, Bates BR. Communication in Neglected Tropical Diseases' elimination: A scoping review and call for action. PLoS Negl Trop Dis 2022; 16:e0009774. [PMID: 36228006 PMCID: PMC9595560 DOI: 10.1371/journal.pntd.0009774] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/25/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Although the practice of communication is often called upon when intervening and involving communities affected by NTDs, the disciplinary framework of health communication research has been largely absent from NTD strategies. To illustrate how practices conceptualized and developed within the communication field have been applied in the context of NTD elimination, we conducted a scoping review focusing on two diseases currently targeted for elimination by the WHO: lymphatic filariasis and Chagas disease. METHODS We examined studies published between 2012 and 2020 in five electronic databases. Selected articles were required to (i) have explicit references to communication in either the abstract, title, or key words; (ii) further elaborate on the search terms (communication, message, media, participation and health education) in the body of the article; and (iii) sufficiently describe communication actions associated to those terms. Using the C-Change Socio-Ecological Model for Social and Behavior Change Communication as a reference, the articles were analysed to identify communication activities, theoretical frameworks, and/or rationales involved in their design, as well as their intended level of influence (individual, interpersonal, community, or enabling environment). RESULTS AND IMPLICATIONS A total of 43 articles were analysed. Most interventions conceptualized communication as a set of support tools or supplemental activities delivering information and amplifying pre-defined messages aimed at increasing knowledge, encouraging community involvement, promoting individual behavior change, or securing some degree of acceptability of proposed strategies. Although important attempts at further exploring communication capabilities were identified, particularly in participation-based strategies, for most studies, communication consisted of an underdeveloped and under-theorized approach. We contend that a more complex understanding of the capacities offered by the health communication field could help attain the biomedical and social justice goals proposed in NTD elimination strategies. Three ways in which the field of health communication could further enhance NTD efforts are presented: informing interventions with theory-based frameworks, exploring the political complexity of community participation in specific contexts, and identifying conceptualizations of culture implied in interventions' design. CONCLUSION This article is a call to action to consider the resources offered by the health communication field when researching, designing, or implementing NTD interventions.
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Affiliation(s)
- Claudia Nieto-Sanchez
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
| | - David M. Hatley
- Department of Epidemiology, University of London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mario J. Grijalva
- Infectious and Tropical Disease Institute (ITDI), Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, United States of America
- Center for Research in Health in Latin America (CISeAL), Facultad de Ciencias Exactas y Naturales, Pontifical Catholic University of Ecuador, Quito, Ecuador
| | - Koen Peeters Grietens
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Nagasaki, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Benjamin R. Bates
- Infectious and Tropical Disease Institute (ITDI), Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, United States of America
- Center for Research in Health in Latin America (CISeAL), Facultad de Ciencias Exactas y Naturales, Pontifical Catholic University of Ecuador, Quito, Ecuador
- School of Communication Studies, Ohio University, Athens, Ohio, United States of America
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Stigma and Discrimination (SAD) at the Time of the SARS-CoV-2 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176341. [PMID: 32878180 PMCID: PMC7503800 DOI: 10.3390/ijerph17176341] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/17/2020] [Accepted: 08/27/2020] [Indexed: 02/03/2023]
Abstract
Infectious disease control is a crucial public health issue. Although it is important to urgently perform public health measures in order to reduce the risk of spread, it could end up stigmatizing entire groups of people rather than offering control measures based on sound scientific principles. This “us” versus “them” dynamic is common in stigmatization, in general, and indicates a way in which disease stigma can be viewed as a proxy for other types of fears, especially xenophobia and general fear of outsiders. The pandemic risk associated with SARS-CoV-2 infection led us to consider, among other related issues, how stigma and discrimination remain serious barriers to care for people suspected of being infected, even more if they are assisting professions, such as health workers, employed in emergency response. The purpose of this review is to evaluate and promote the importance of psychological aspects of the stigma and social discrimination (SAD) in pandemic realities and, more specifically, nowadays, in the context of SARS-CoV-2/COVID-19. Just as it happened with HIV, HCV, tuberculosis, and Zika, stigma and discrimination undermine the social fabric compromising the ethics and principles of civilization to which each individual in entitled. Recognizing disease stigma history can give us insight into how, exactly, stigmatizing attitudes are formed, and how they are disbanded. Instead of simply blaming the ignorance of people espousing stigmatizing attitudes about certain diseases, we should try to understand precisely how these attitudes are formed so that we can intervene in their dissemination. We should also look at history to see what sorts of interventions against stigma may have worked in the past. Ongoing research into stigma should evaluate what has worked in the past, as above-mentioned, providing us with some clues as to what might work in the current pandemic emergency, to reduce devastating discrimination that keeps people from getting the care they need. We propose a systematic and historical review, in order to create a scientific and solid base for the following SAD analysis. The aim is to propose a coping strategy to face stigma and discrimination (SAD) related to SARS-CoV-2/COVID-19 pandemic outbreak, borrowing coping strategy tools and solutions from other common contagious diseases. Furthermore, our study observes how knowledge, education level, and socioeconomic status (SES) can influence perception of SARS-CoV-2/ COVID-19 risk in a digital world, based on previous research, best practices, and evidence-based research.
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Buttenheim AM, Levy MZ, Castillo-Neyra R, McGuire M, Toledo Vizcarra AM, Mollesaca Riveros LM, Meza J, Borrini-Mayori K, Naquira C, Behrman J, Paz-Soldan VA. A behavioral design approach to improving a Chagas disease vector control campaign in Peru. BMC Public Health 2019; 19:1272. [PMID: 31533762 PMCID: PMC6751594 DOI: 10.1186/s12889-019-7525-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 08/21/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Individual behavior change is a critical ingredient in efforts to improve global health. Central to the focus on behavior has been a growing understanding of how the human brain makes decisions, from motivations and mindsets to unconscious biases and cognitive shortcuts. Recent work in the field of behavioral economics and related fields has contributed to a rich menu of insights and principles that can be engineered into global health programs to increase impact and reach. However, there is little research on the process of designing and testing interventions informed by behavioral insights. METHODS In a study focused on increasing household participation in a Chagas disease vector control campaign in Arequipa, Peru, we applied Datta and Mullainathan's "behavioral design" approach to formulate and test specific interventions. In this Technical Advance article we describe the behavioral design approach in detail, including the Define, Diagnosis, Design, and Test phases. We also show how the interventions designed through the behavioral design process were adapted for a pragmatic randomized controlled field trial. RESULTS The behavioral design framework provided a systematic methodology for defining the behavior of interest, diagnosing reasons for household reluctance or refusal to participate, designing interventions to address actionable bottlenecks, and then testing those interventions in a rigorous counterfactual context. Behavioral design offered us a broader range of strategies and approaches than are typically used in vector control campaigns. CONCLUSIONS Careful attention to how behavioral design may affect internal and external validity of evaluations and the scalability of interventions is needed going forward. We recommend behavioral design as a useful complement to other intervention design and evaluation approaches in global health programs.
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Affiliation(s)
- Alison M. Buttenheim
- Department of Family and Community Health, University of Pennsylvania School of Nursing, 418 Curie Boulevard, 416 Fagin Hall, Philadelphia, PA 19104 USA
| | - Michael Z. Levy
- Department of Biostatistics, Epidemiology, and Informatics, Perleman School of Medicine of the University of Pennsylvana, Philadelphia, PA USA
| | - Ricardo Castillo-Neyra
- Department of Biostatistics, Epidemiology, and Informatics, Perleman School of Medicine of the University of Pennsylvana, Philadelphia, PA USA
| | - Molly McGuire
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA USA
- Chagas Disease Working Group, Arequipa, Peru
| | | | | | - Julio Meza
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Katty Borrini-Mayori
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cesar Naquira
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jere Behrman
- Department of Economics, University of Pennsylvania, Philadelphia, PA USA
| | - Valerie A. Paz-Soldan
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA USA
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Usuga AF, Zuluaga-Idárraga LM, Alvarez N, Rojo R, Henao E, Rúa-Uribe GL. Barriers that limit the implementation of thermal fogging for the control of dengue in Colombia: a study of mixed methods. BMC Public Health 2019; 19:669. [PMID: 31146722 PMCID: PMC6543676 DOI: 10.1186/s12889-019-7029-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 05/22/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Thermal fogging of Insecticides is a vector control strategy used by the Medellin Secretary of Health to combat dengue. This method is employed during outbreaks to curb populations of potentially infectious adult mosquitoes and interrupt transmission cycles. While this strategy has been used in Medellin since 2007, in some years it has not reduced dengue cases as expected. Difficulties in the implementation of fumigation strategies, such as lack of opportunity for treatment and public perception may be factors that limit its utility. The objective of this study was to identify barriers that hinder the implementation of thermal fogging, as well as attitudes and beliefs that prevent its acceptance. METHODS We used a cross-sectional observational study of mixed methods carried out in neighborhoods prioritized for fumigation treatment in Medellin, Colombia. First, we assessed the timeliness of treatment by determining the latency period between reported dengue cases and the implementation of fumigation in response to those cases. Next, we administered structured questionnaires to residents in the area of fumigation treatments (n = 4455 homes) to quantify acceptance and rejection, as well as factors associated with rejection. RESULTS The median time between notification and treatment was 25 days (IQR 20.0-36.5). Fumigators were only able to treat 53.7% of total households scheduled for treatment; 9.6% rejected treatment, and treatment teams were unable to fumigate the remaining 36.7% of homes due to absent residents, no adults being present, and other reasons. The most frequent causes for rejection were residents being busy at the time of treatment (33.1%) and no interest in the treatment (24.5%). Other reasons for rejection include the perceptions that fumigation does not control pests other than mosquitoes (4.3%), that no mosquitoes were present in the home (3.3%), and that fumigation affects human health (3.1%). CONCLUSIONS The high percentage of houses where it was not possible to perform fumigation limits control of the vector. Future strategies should consider more flexible treatment schedules and incorporate informational messages to educate residents about the safety and importance of treatment.
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Affiliation(s)
- Andrés F Usuga
- Grupo Epidemiología, Linea enfermedades infecciosas, Facultad Nacional de Salud Pública, Universidad de Antioquia, Calle 62 # 52-60, Antioquia, Medellin, Colombia. .,Grupo Entomología Médica, Facultad de Medicina, Universidad de Antioquia, Carrera 51d # 62-29 Lab. 303, Antioquia, Medellin, Colombia.
| | - Lina M Zuluaga-Idárraga
- Grupo Salud y Ambiente, Facultad Nacional de Salud Pública, Universidad de Antioquia, Calle 62 # 52-59, Antioquia, Medellin, Colombia
| | - Natalia Alvarez
- Grupo de Investigación Diverser, Facultad de Educación, Universidad de Antioquia, Calle 62 # 52-59, Antioquia, Medellin, Colombia
| | - Raúl Rojo
- Secretaría de Salud de Medellin, Carrera 53ª # 42-101 piso 10, Antioquia, Medellin, Colombia
| | - Enrique Henao
- Secretaría de Salud de Medellin, Carrera 53ª # 42-101 piso 10, Antioquia, Medellin, Colombia
| | - Guillermo L Rúa-Uribe
- Grupo Entomología Médica, Facultad de Medicina, Universidad de Antioquia, Carrera 51d # 62-29 Lab. 303, Antioquia, Medellin, Colombia
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Gutfraind A, Peterson JK, Billig Rose E, Arevalo-Nieto C, Sheen J, Condori-Luna GF, Tankasala N, Castillo-Neyra R, Condori-Pino C, Anand P, Naquira-Velarde C, Levy MZ. Integrating evidence, models and maps to enhance Chagas disease vector surveillance. PLoS Negl Trop Dis 2018; 12:e0006883. [PMID: 30496172 PMCID: PMC6289469 DOI: 10.1371/journal.pntd.0006883] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 12/11/2018] [Accepted: 09/29/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Until recently, the Chagas disease vector, Triatoma infestans, was widespread in Arequipa, Perú, but as a result of a decades-long campaign in which over 70,000 houses were treated with insecticides, infestation prevalence is now greatly reduced. To monitor for T. infestans resurgence, the city is currently in a surveillance phase in which a sample of houses is selected for inspection each year. Despite extensive data from the control campaign that could be used to inform surveillance, the selection of houses to inspect is often carried out haphazardly or by convenience. Therefore, we asked, how can we enhance efforts toward preventing T. infestans resurgence by creating the opportunity for vector surveillance to be informed by data? METHODOLOGY/PRINCIPAL FINDINGS To this end, we developed a mobile app that provides vector infestation risk maps generated with data from the control campaign run in a predictive model. The app is intended to enhance vector surveillance activities by giving inspectors the opportunity to incorporate the infestation risk information into their surveillance activities, but it does not dictate which houses to surveil. Therefore, a critical question becomes, will inspectors use the risk information? To answer this question, we ran a pilot study in which we compared surveillance using the app to the current practice (paper maps). We hypothesized that inspectors would use the risk information provided by the app, as measured by the frequency of higher risk houses visited, and qualitative analyses of inspector movement patterns in the field. We also compared the efficiency of both mediums to identify factors that might discourage risk information use. Over the course of ten days (five with each medium), 1,081 houses were visited using the paper maps, of which 366 (34%) were inspected, while 1,038 houses were visited using the app, with 401 (39%) inspected. Five out of eight inspectors (62.5%) visited more higher risk houses when using the app (Fisher's exact test, p < 0.001). Among all inspectors, there was an upward shift in proportional visits to higher risk houses when using the app (Mantel-Haenszel test, common odds ratio (OR) = 2.42, 95% CI 2.00-2.92), and in a second analysis using generalized linear mixed models, app use increased the odds of visiting a higher risk house 2.73-fold (95% CI 2.24-3.32), suggesting that the risk information provided by the app was used by most inspectors. Qualitative analyses of inspector movement revealed indications of risk information use in seven out of eight (87.5%) inspectors. There was no difference between the app and paper maps in the number of houses visited (paired t-test, p = 0.67) or inspected (p = 0.17), suggesting that app use did not reduce surveillance efficiency. CONCLUSIONS/SIGNIFICANCE Without staying vigilant to remaining and re-emerging vector foci following a vector control campaign, disease transmission eventually returns and progress achieved is reversed. Our results suggest that, when provided the opportunity, most inspectors will use risk information to direct their surveillance activities, at least over the short term. The study is an initial, but key, step toward evidence-based vector surveillance.
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Affiliation(s)
- Alexander Gutfraind
- Laboratory for Mathematical Analysis of Data, Complexity and Conflicts, Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL, United States of America
- Division of Hepatology, Department of Medicine, Loyola University Medical Center, Maywood, IL, United States of America
| | - Jennifer K. Peterson
- Department of Biostatistics, Epidemiology & Informatics; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Erica Billig Rose
- Department of Biostatistics, Epidemiology & Informatics; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Claudia Arevalo-Nieto
- Zoonotic Disease Research Laboratory, One Health Unit, Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Justin Sheen
- Department of Biostatistics, Epidemiology & Informatics; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Zoonotic Disease Research Laboratory, One Health Unit, Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Gian Franco Condori-Luna
- Zoonotic Disease Research Laboratory, One Health Unit, Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Narender Tankasala
- Laboratory for Mathematical Analysis of Data, Complexity and Conflicts, Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Ricardo Castillo-Neyra
- Department of Biostatistics, Epidemiology & Informatics; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Carlos Condori-Pino
- Zoonotic Disease Research Laboratory, One Health Unit, Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Priyanka Anand
- Department of Biostatistics, Epidemiology & Informatics; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Cesar Naquira-Velarde
- Zoonotic Disease Research Laboratory, One Health Unit, Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Michael Z. Levy
- Department of Biostatistics, Epidemiology & Informatics; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
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Gaspe MS, Provecho YM, Fernández MP, Vassena CV, Santo Orihuela PL, Gürtler RE. Beating the odds: Sustained Chagas disease vector control in remote indigenous communities of the Argentine Chaco over a seven-year period. PLoS Negl Trop Dis 2018; 12:e0006804. [PMID: 30278044 PMCID: PMC6168123 DOI: 10.1371/journal.pntd.0006804] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/29/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Rapid reinfestation of insecticide-treated dwellings hamper the sustained elimination of Triatoma infestans, the main vector of Chagas disease in the Gran Chaco region. We conducted a seven-year longitudinal study including community-wide spraying with pyrethroid insecticides combined with periodic vector surveillance to investigate the house reinfestation process in connection with baseline pyrethroid resistance, housing quality and household mobility in a rural section of Pampa del Indio mainly inhabited by deprived indigenous people (Qom). METHODOLOGY/PRINCIPAL FINDINGS Despite evidence of moderate pyrethroid resistance in local T. infestans populations, house infestation dropped from 31.9% at baseline to 0.7% at 10 months post-spraying (MPS), with no triatomine found at 59 and 78 MPS. Household-based surveillance corroborated the rare occurrence of T. infestans and the house invasion of other four triatomine species. The annual rates of loss of initially occupied houses and of household mobility were high (4.6-8.0%). Housing improvements did not translate into a significant reduction of mud-walled houses and refuges for triatomines because most households kept the former dwelling or built new ones with mud walls. CONCLUSIONS/SIGNIFICANCE Our results refute the assumption that vector control actions performed in marginalized communities of the Gran Chaco are doomed to fail. The larger-than-expected impacts of the intervention program were likely associated with the combined effects of high-coverage, professional insecticide spraying followed by systematic vector surveillance-and-response, broad geographic coverage creating a buffer zone, frequent housing replacement and residential mobility. The dynamical interactions among housing quality, mobility and insecticide-based control largely affect the chances of vector elimination.
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Affiliation(s)
- M. Sol Gaspe
- Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales, Laboratorio de Eco-Epidemiología, Ciudad Universitaria, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas-Universidad de Buenos Aires. Instituto de Ecología, Genética y Evolución de Buenos Aires (IEGEBA), Ciudad Universitaria, Buenos Aires, Argentina
| | - Yael M. Provecho
- Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales, Laboratorio de Eco-Epidemiología, Ciudad Universitaria, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas-Universidad de Buenos Aires. Instituto de Ecología, Genética y Evolución de Buenos Aires (IEGEBA), Ciudad Universitaria, Buenos Aires, Argentina
- Coordinación de Vectores, Dirección Nacional de Epidemiología y Análisis de la Situación de Salud, Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - María P. Fernández
- Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales, Laboratorio de Eco-Epidemiología, Ciudad Universitaria, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas-Universidad de Buenos Aires. Instituto de Ecología, Genética y Evolución de Buenos Aires (IEGEBA), Ciudad Universitaria, Buenos Aires, Argentina
- Earth Institute, Columbia University, New York, New York, United States of America
| | - Claudia V. Vassena
- Centro de Investigaciones de Plagas e Insecticidas (UNIDEF, CITEDEF, CONICET, CIPEIN), Buenos Aires, Argentina
- Cátedra de Química Analítica Instrumental, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Pablo L. Santo Orihuela
- Centro de Investigaciones de Plagas e Insecticidas (UNIDEF, CITEDEF, CONICET, CIPEIN), Buenos Aires, Argentina
- Departamento de Investigación e Ingeniería Ambiental (3iA), Universidad Nacional de San Martín, Buenos Aires, Argentina
| | - Ricardo E. Gürtler
- Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales, Laboratorio de Eco-Epidemiología, Ciudad Universitaria, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas-Universidad de Buenos Aires. Instituto de Ecología, Genética y Evolución de Buenos Aires (IEGEBA), Ciudad Universitaria, Buenos Aires, Argentina
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10
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Buttenheim AM, Paz-Soldán VA, Castillo-Neyra R, Toledo Vizcarra AM, Borrini-Mayori K, McGuire M, Arevalo-Nieto C, Volpp KG, Small DS, Behrman JR, Naquira-Verlarde C, Levy MZ. Increasing participation in a vector control campaign: a cluster randomised controlled evaluation of behavioural economic interventions in Peru. BMJ Glob Health 2018; 3:e000757. [PMID: 30271624 PMCID: PMC6157568 DOI: 10.1136/bmjgh-2018-000757] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 07/30/2018] [Accepted: 08/03/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the efficacy of strategies informed by behavioural economics for increasing participation in a vector control campaign, compared with current practice. DESIGN Pragmatic cluster randomised controlled trial. SETTING Arequipa, Peru. PARTICIPANTS 4922 households. INTERVENTIONS Households were randomised to one of four arms: advanced planning, leader recruitment, contingent group lotteries, or control. MAIN OUTCOME MEASURES Participation (allowing the house to be sprayed with insecticide) during the vector control campaign. RESULTS In intent-to-treat analyses, none of the interventions increased participation compared with control (advanced planning adjusted OR (aOR) 1.07 (95% CI 0.87 to 1.32); leader recruitment aOR 0.95 (95% CI 0.78 to 1.15); group lotteries aOR 1.12 (95% CI 0.89 to 1.39)). The interventions did not improve the efficiency of the campaign (additional minutes needed to spray house from generalised estimating equation regressions: advanced planning 1.08 (95% CI -1.02 to 3.17); leader recruitment 3.91 (95% CI 1.85 to 5.97); group lotteries 3.51 (95% CI 1.38 to 5.64)) nor did it increase the odds that houses would be sprayed in an earlier versus a later stage of the campaign cycle (advanced planning aOR 0.94 (95% CI 0.76 to 1.25); leader recruitment aOR 0.68 (95% CI 0.55 to 0.83); group lotteries aOR 1.19 (95% CI 0.96 to 1.47)). A post hoc analysis suggested that advanced planning increased odds of participation compared with control among households who had declined to participate previously (aOR 2.50 (95% CI 1.41 to 4.43)). CONCLUSIONS Achieving high levels of household participation is crucial for many disease prevention efforts. Our trial was not successful in improving participation compared with the existing campaign. The trial highlights persistent challenges to field experiments as well as lessons about the intervention design process, particularly understanding barriers to participation through a behavioural lens. TRIAL REGISTRATION NUMBER American Economic Association AEARCTR-0000620.
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Affiliation(s)
- Alison M Buttenheim
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Valerie A Paz-Soldán
- Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, USA
| | - Ricardo Castillo-Neyra
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Amparo M Toledo Vizcarra
- Zoonotic Disease Research Lab, OneHealth Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
| | - Katty Borrini-Mayori
- Zoonotic Disease Research Lab, OneHealth Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
| | - Molly McGuire
- Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, USA
| | - Claudia Arevalo-Nieto
- Zoonotic Disease Research Lab, OneHealth Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
| | - Kevin G Volpp
- Medical Ethics and Health Policy, School of Medicine, University of Pennsylvania Perelman, Philadelphia, Pennsylvania, USA
| | - Dylan S Small
- Department of Statistics, University of Pennsylvania Wharton School, Philadelphia, Pennsylvania, USA
| | - Jere R Behrman
- Department of Economics School of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Michael Z Levy
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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11
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Barbu CM, Sethuraman K, Billig EMW, Levy MZ. Two-scale dispersal estimation for biological invasions via synthetic likelihood. ECOGRAPHY 2018; 41:661-672. [PMID: 30104817 PMCID: PMC6086346 DOI: 10.1111/ecog.02575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Biological invasions reshape environments and affect the ecological and economic welfare of states and communities. Such invasions advance on multiple spatial scales, complicating their control. When modeling stochastic dispersal processes, intractable likelihoods and autocorrelated data complicate parameter estimation. As with other approaches, the recent synthetic likelihood framework for stochastic models uses summary statistics to reduce this complexity; however, it additionally provides usable likelihoods, facilitating the use of existing likelihood-based machinery. Here, we extend this framework to parameterize multi-scale spatio-temporal dispersal models and compare existing and newly developed spatial summary statistics to characterize dispersal patterns. We provide general methods to evaluate potential summary statistics and present a fitting procedure that accurately estimates dispersal parameters on simulated data. Finally, we apply our methods to quantify the short and long range dispersal of Chagas disease vectors in urban Arequipa, Peru, and assess the feasibility of a purely reactive strategy to contain the invasion.
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Affiliation(s)
- Corentin M. Barbu
- Department of Biostatistics & Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
- UMR Agronomie, INRA, AgroParisTech, Université Paris-Saclay, 78850 Thiverval-Grignon, France
| | - Karthik Sethuraman
- Department of Biostatistics & Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Erica M. W. Billig
- Department of Biostatistics & Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Michael Z. Levy
- Department of Biostatistics & Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
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12
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Castillo-Neyra R, Brown J, Borrini K, Arevalo C, Levy MZ, Buttenheim A, Hunter GC, Becerra V, Behrman J, Paz-Soldan VA. Barriers to dog rabies vaccination during an urban rabies outbreak: Qualitative findings from Arequipa, Peru. PLoS Negl Trop Dis 2017; 11:e0005460. [PMID: 28306717 PMCID: PMC5371379 DOI: 10.1371/journal.pntd.0005460] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 03/29/2017] [Accepted: 03/06/2017] [Indexed: 12/25/2022] Open
Abstract
Background Canine rabies was reintroduced to the city of Arequipa, Peru in March 2015. The Ministry of Health has conducted a series of mass dog vaccination campaigns to contain the outbreak, but canine rabies virus transmission continues in Arequipa’s complex urban environment, putting the city’s 1 million inhabitants at risk of infection. The proximate driver of canine rabies in Arequipa is low dog vaccination coverage. Our objectives were to qualitatively assess barriers to and facilitators of rabies vaccination during mass campaigns, and to explore strategies to increase participation in future efforts. Methodology/Principal findings We conducted 8 focus groups (FG) in urban and peri-urban communities of Mariano Melgar district; each FG included both sexes, and campaign participants and non-participants. All FG were transcribed and then coded independently by two coders. Results were summarized using the Social Ecological Model. At the individual level, participants described not knowing enough about rabies and vaccination campaigns, mistrusting the campaign, and being unable to handle their dogs, particularly in peri-urban vs. urban areas. At the interpersonal level, we detected some social pressure to vaccinate dogs, as well as some disparaging of those who invest time and money in pet dogs. At the organizational level, participants found the campaign information to be insufficient and ill-timed, and campaign locations and personnel inadequate. At the community level, the influence of landscape and topography on accessibility to vaccination points was reported differently between participants from the urban and peri-urban areas. Poor security and impermanent housing materials in the peri-urban areas also drives higher prevalence of guard dog ownership for home protection; these dogs usually roam freely on the streets and are more difficult to handle and bring to the vaccination points. Conclusions A well-designed communication campaign could improve knowledge about canine rabies. Timely messages on where and when vaccination is occurring could increase dog owners’ perception of their own ability to bring their dogs to the vaccination points and be part of the campaign. Small changes in the implementation of the campaign at the vaccination points could increase the public’s trust and motivation. Location of vaccination points should take into account landscape and community concerns. Canine rabies was reintroduced in Arequipa, Peru in March 2015, a rare event in an area previously declared free of transmission. In Arequipa, annual mass dog vaccination is practiced as a preventive strategy, with additional campaigns being implemented since the recent detection of the virus. However, these additional efforts have not quelled the outbreak and low dog vaccination coverage is driving ongoing transmission. We conducted focus groups in urban and peri-urban areas of Arequipa to identify barriers to and facilitators of canine vaccination during mass campaigns. Based on our findings, communication campaigns should seek to increase knowledge about canine rabies and the vaccination campaign, and provide timely messages on where and when vaccination is occurring. Small changes at the campaign’s vaccination points could increase public’s trust. Finally, there are differences between urban and peri-urban areas, such as landscape and topography that affect participation in mass vaccination campaigns and that should be considered when selecting locations for vaccination points.
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Affiliation(s)
- Ricardo Castillo-Neyra
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Zoonotic Disease Research Lab, Universidad Peruana Cayetano Heredia, Lima, Perú
- * E-mail:
| | - Joanna Brown
- Zoonotic Disease Research Lab, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Katty Borrini
- Zoonotic Disease Research Lab, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Claudia Arevalo
- Zoonotic Disease Research Lab, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Michael Z. Levy
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Zoonotic Disease Research Lab, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Alison Buttenheim
- Zoonotic Disease Research Lab, Universidad Peruana Cayetano Heredia, Lima, Perú
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States
| | - Gabrielle C. Hunter
- Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Victor Becerra
- Microred Mariano Melgar, Ministerio de Salud, Arequipa, Perú
| | - Jere Behrman
- Department of Economics, University of Pennsylvania School of Arts and Sciences, Philadelphia, Pennsylvania, United States of America
- Department of Sociology, University of Pennsylvania School of Arts and Sciences, Philadelphia, Pennsylvania, United States of America
| | - Valerie A. Paz-Soldan
- Zoonotic Disease Research Lab, Universidad Peruana Cayetano Heredia, Lima, Perú
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Perú
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13
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Dias JVL, Queiroz DRM, Diotaiuti L, Pires HHR. Conhecimentos sobre triatomíneos e sobre a doença de Chagas em localidades com diferentes níveis de infestação vetorial. CIENCIA & SAUDE COLETIVA 2016; 21:2293-304. [DOI: 10.1590/1413-81232015217.07792015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 09/11/2015] [Indexed: 11/22/2022] Open
Abstract
Resumo A participação comunitária é a principal estratégia para a manutenção da vigilância entomológica da doença de Chagas. O objetivo deste estudo foi avaliar conhecimentos sobre triatomíneos e a doença de Chagas entre moradores de oito localidades de Diamantina, Minas Gerais, atentando a uma eventual relação entre os conhecimentos e a infestação vetorial. Para avaliação dos conhecimentos foi aplicado questionário com questões fechadas e abertas a 583 moradores com idade igual ou superior a dez anos e, para avaliar a capacidade de reconhecimento de triatomíneos, foi apresentado mostruário com insetos. As respostas às questões fechadas foram analisadas quanto à frequência e associação com a infestação triatomínica. As respostas às questões abertas foram organizadas em eixos temáticos e analisadas descritivamente. Embora a capacidade de reconhecer os triatomíneos não tenha sido associada à infestação das localidades, os residentes em áreas com maior infestação demonstraram conhecer melhor os serviços de referência e a necessidade de encaminhar os insetos a estes. Não foi observada associação entre a infestação triatomínica e os conhecimentos sobre a doença de Chagas. Os resultados ora apresentados podem orientar ações de educação em saúde voltadas para a participação da comunidade na notificação de triatomíneos.
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Affiliation(s)
| | | | - Liléia Diotaiuti
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Brasil
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14
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Paz-Soldán VA, Bauer KM, Hunter GC, Castillo-Neyra R, Arriola VD, Rivera-Lanas D, Rodriguez GH, Toledo Vizcarra AM, Mollesaca Riveros LM, Levy MZ, Buttenheim AM. To spray or not to spray? Understanding participation in an indoor residual spray campaign in Arequipa, Peru. Glob Public Health 2016; 13:65-82. [PMID: 27189446 DOI: 10.1080/17441692.2016.1178317] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Current low participation rates in vector control programmes in Arequipa, Peru complicate the control of Chagas disease. Using focus groups (n = 17 participants) and semi-structured interviews (n = 71) conducted in March and May 2013, respectively, we examined barriers to and motivators of household participation in an indoor residual spray (IRS) campaign that had taken place one year prior in Arequipa. The most common reported barriers to participation were inconvenient spray times due to work obligations, not considering the campaign to be necessary, concerns about secondary health impacts (e.g. allergic reactions to insecticides), and difficulties preparing the home for spraying (e.g. moving heavy furniture). There was also a low perception of risk for contracting Chagas disease that might affect participation. The main motivator to participate was to ensure personal health and well-being. Future IRS campaigns should incorporate more flexible hours, including weekends; provide appropriate educational messages to counter concerns about secondary health effects; incorporate peer educators to increase perceived risk to Chagas in community; obtain support from community members and leaders to build community trust and support for the campaign; and assist individuals in preparing their homes. Enhancing community trust in both the need for the campaign and its operations is key.
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Affiliation(s)
- Valerie A Paz-Soldán
- a Department of Global Community Health and Behavioral Sciences , Tulane University School of Public Health and Tropical Medicine , New Orleans , LA , USA.,b Facultad de Salud Pública y Administración , Universidad Peruana Cayetano Heredia , Lima , Perú
| | - Karin M Bauer
- a Department of Global Community Health and Behavioral Sciences , Tulane University School of Public Health and Tropical Medicine , New Orleans , LA , USA
| | - Gabrielle C Hunter
- c Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Ricardo Castillo-Neyra
- d Department of Biostatistics and Epidemiology , University of Pennsylvania Perelman School of Medicine , Philadelphia , PA , USA.,e Facultad de Ciencias y Filosofía , Universidad Peruana Cayetano Heredia , Lima , Perú
| | - Vanessa D Arriola
- f Department of Epidemiology , Tulane University , New Orleans , LA , USA
| | - Daniel Rivera-Lanas
- d Department of Biostatistics and Epidemiology , University of Pennsylvania Perelman School of Medicine , Philadelphia , PA , USA
| | - Geoffrey H Rodriguez
- d Department of Biostatistics and Epidemiology , University of Pennsylvania Perelman School of Medicine , Philadelphia , PA , USA
| | | | | | - Michael Z Levy
- d Department of Biostatistics and Epidemiology , University of Pennsylvania Perelman School of Medicine , Philadelphia , PA , USA.,e Facultad de Ciencias y Filosofía , Universidad Peruana Cayetano Heredia , Lima , Perú
| | - Alison M Buttenheim
- g Department of Family and Community Health , University of Pennsylvania School of Nursing , Philadelphia , PA , USA.,h Center for Health Incentives and Behavioral Economics , University of Pennsylvania , Philadelphia , PA , USA
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15
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Barbu CM, Buttenheim AM, Pumahuanca MLH, Calderón JEQ, Salazar R, Carrión M, Rospigliossi AC, Chavez FSM, Alvarez KO, Cornejo del Carpio J, Náquira C, Levy MZ. Residual infestation and recolonization during urban Triatoma infestans Bug Control Campaign, Peru. Emerg Infect Dis 2016; 20:2055-63. [PMID: 25423045 PMCID: PMC4257819 DOI: 10.3201/eid2012.131820] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Chagas disease vector control campaigns are being conducted in Latin America, but little is known about medium-term or long-term effectiveness of these efforts, especially in urban areas. After analyzing entomologic data for 56,491 households during the treatment phase of a Triatoma infestans bug control campaign in Arequipa, Peru, during 2003-2011, we estimated that 97.1% of residual infestations are attributable to untreated households. Multivariate models for the surveillance phase of the campaign obtained during 2009-2012 confirm that nonparticipation in the initial treatment phase is a major risk factor (odds ratio [OR] 21.5, 95% CI 3.35-138). Infestation during surveillance also increased over time (OR 1.55, 95% CI 1.15-2.09 per year). In addition, we observed a negative interaction between nonparticipation and time (OR 0.73, 95% CI 0.53-0.99), suggesting that recolonization by vectors progressively dilutes risk associated with nonparticipation. Although the treatment phase was effective, recolonization in untreated households threatens the long-term success of vector control.
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16
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Levy MZ, Tustin A, Castillo-Neyra R, Mabud TS, Levy K, Barbu CM, Quispe-Machaca VR, Ancca-Juarez J, Borrini-Mayori K, Naquira-Velarde C, Ostfeld RS. Bottlenecks in domestic animal populations can facilitate the emergence of Trypanosoma cruzi, the aetiological agent of Chagas disease. Proc Biol Sci 2016; 282:rspb.2014.2807. [PMID: 26085582 DOI: 10.1098/rspb.2014.2807] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Faeces-mediated transmission of Trypanosoma cruzi (the aetiological agent of Chagas disease) by triatomine insects is extremely inefficient. Still, the parasite emerges frequently, and has infected millions of people and domestic animals. We synthesize here the results of field and laboratory studies of T. cruzi transmission conducted in and around Arequipa, Peru. We document the repeated occurrence of large colonies of triatomine bugs (more than 1000) with very high infection prevalence (more than 85%). By inoculating guinea pigs, an important reservoir of T. cruzi in Peru, and feeding triatomine bugs on them weekly, we demonstrate that, while most animals quickly control parasitaemia, a subset of animals remains highly infectious to vectors for many months. However, we argue that the presence of these persistently infectious hosts is insufficient to explain the observed prevalence of T. cruzi in vector colonies. We posit that seasonal rains, leading to a fluctuation in the price of guinea pig food (alfalfa), leading to annual guinea pig roasts, leading to a concentration of vectors on a small subpopulation of animals maintained for reproduction, can propel T. cruzi through vector colonies and create a considerable force of infection for a pathogen whose transmission might otherwise fizzle out.
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Affiliation(s)
- Michael Z Levy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA Universidad Peruana Cayetano Heredia/University of Pennsylvania Chagas Disease Field Laboratory, Arequipa, Peru
| | - Aaron Tustin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ricardo Castillo-Neyra
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA Universidad Peruana Cayetano Heredia/University of Pennsylvania Chagas Disease Field Laboratory, Arequipa, Peru
| | - Tarub S Mabud
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Katelyn Levy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Corentin M Barbu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA Universidad Peruana Cayetano Heredia/University of Pennsylvania Chagas Disease Field Laboratory, Arequipa, Peru
| | - Victor R Quispe-Machaca
- Universidad Peruana Cayetano Heredia/University of Pennsylvania Chagas Disease Field Laboratory, Arequipa, Peru
| | - Jenny Ancca-Juarez
- Universidad Peruana Cayetano Heredia/University of Pennsylvania Chagas Disease Field Laboratory, Arequipa, Peru
| | - Katty Borrini-Mayori
- Universidad Peruana Cayetano Heredia/University of Pennsylvania Chagas Disease Field Laboratory, Arequipa, Peru
| | - Cesar Naquira-Velarde
- Universidad Peruana Cayetano Heredia/University of Pennsylvania Chagas Disease Field Laboratory, Arequipa, Peru
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17
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LaDeau SL, Allan BF, Leisnham PT, Levy MZ. The ecological foundations of transmission potential and vector-borne disease in urban landscapes. Funct Ecol 2015; 29:889-901. [PMID: 26549921 PMCID: PMC4631442 DOI: 10.1111/1365-2435.12487] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Urban transmission of arthropod-vectored disease has increased in recent decades. Understanding and managing transmission potential in urban landscapes requires integration of sociological and ecological processes that regulate vector population dynamics, feeding behavior, and vector-pathogen interactions in these unique ecosystems. Vectorial capacity is a key metric for generating predictive understanding about transmission potential in systems with obligate vector transmission. This review evaluates how urban conditions, specifically habitat suitability and local temperature regimes, and the heterogeneity of urban landscapes can influence the biologically-relevant parameters that define vectorial capacity: vector density, survivorship, biting rate, extrinsic incubation period, and vector competence.Urban landscapes represent unique mosaics of habitat. Incidence of vector-borne disease in urban host populations is rarely, if ever, evenly distributed across an urban area. The persistence and quality of vector habitat can vary significantly across socio-economic boundaries to influence vector species composition and abundance, often generating socio-economically distinct gradients of transmission potential across neighborhoods.Urban regions often experience unique temperature regimes, broadly termed urban heat islands (UHI). Arthropod vectors are ectothermic organisms and their growth, survival, and behavior are highly sensitive to environmental temperatures. Vector response to UHI conditions is dependent on regional temperature profiles relative to the vector's thermal performance range. In temperate climates UHI can facilitate increased vector development rates while having countervailing influence on survival and feeding behavior. Understanding how urban heat island (UHI) conditions alter thermal and moisture constraints across the vector life cycle to influence transmission processes is an important direction for both empirical and modeling research.There remain persistent gaps in understanding of vital rates and drivers in mosquito-vectored disease systems, and vast holes in understanding for other arthropod vectored diseases. Empirical studies are needed to better understand the physiological constraints and socio-ecological processes that generate heterogeneity in critical transmission parameters, including vector survival and fitness. Likewise, laboratory experiments and transmission models must evaluate vector response to realistic field conditions, including variability in sociological and environmental conditions.
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Affiliation(s)
| | - Brian F. Allan
- Department of Entomology, University of Illinois, Urbana, IL, USA
| | - Paul T. Leisnham
- Concentration in Ecosystem Health and Natural Resource Management, Department of Environmental Science & Technology, University of Maryland, College Park, MD, USA
| | - Michael Z. Levy
- Department of Biostatistics & Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
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