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Abdul Halim AFN, Ahmad D, Miaw Yn JL, Masdor NA, Ramly N, Othman R, Kandayah T, Hassan MR, Dapari R. Factors Associated with the Acceptability of Mass Drug Administration for Filariasis: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12971. [PMID: 36232271 PMCID: PMC9566436 DOI: 10.3390/ijerph191912971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
Mass drug administration (MDA) has been implemented as a tool to eliminate lymphatic filariasis. Acceptability among susceptible populations is crucial to achieving MDA effective coverage. This systematic review aims to present and systematically determine the factors associated with the acceptability of MDA. Articles related to factors associated with acceptability were collected electronically from three different databases (Scopus, Web of Science, and PubMed). Four pairs of independent reviewers screened the titles and abstracts of the collected data, stored in EndnoteX7, against the inclusion criteria. Afterwards, the included articles have been critically appraised to assess the quality of the studies using the Mixed Method Appraisal Tool (MMAT). Of the 68 articles identified, 11 were included in the final review. Knowledge, awareness, attitude and perceptions, communications, delivery and accessibility of MDA, gender, and age are the factors associated with MDA acceptability. Community acceptance remains a challenge in the implementation of MDA. To expand MDA coverage in all endemic countries, there is a strong need to address the factors influencing community acceptance of MDA.
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Affiliation(s)
| | - Dzulfitree Ahmad
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Jane Ling Miaw Yn
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Noor Azreen Masdor
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Nurfatehar Ramly
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Rahayu Othman
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Thinakaran Kandayah
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Mohd Rohaizat Hassan
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu 88400, Malaysia
| | - Rahmat Dapari
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia
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Njomo DW, Kimani BW, Kibe LW, Okoyo C, Omondi WP, Sultani HM. Implementation challenges and opportunities for improved mass treatment uptake for lymphatic filariasis elimination: Perceptions and experiences of community drug distributors of coastal Kenya. PLoS Negl Trop Dis 2020; 14:e0009012. [PMID: 33370300 PMCID: PMC7793263 DOI: 10.1371/journal.pntd.0009012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 01/08/2021] [Accepted: 11/25/2020] [Indexed: 11/29/2022] Open
Abstract
Community drug distributors (CDDs) who are volunteers have the responsibility of awareness creation, household census, drug distribution and record-keeping and are thus key stakeholders in the campaign for Lymphatic Filariasis (LF) elimination. Taking into account their experiences and perceptions is important for a successful elimination campaign. We conducted a qualitative study in 2018 to identify implementation challenges and opportunities for improved mass drug administration (MDA) uptake based on the CDDs perceptions and experiences. Within a larger study that used mixed methods quasi-experimental design, we collected qualitative data from two wards in Kaloleni Sub-County of Kilifi County which was purposively selected owing to its low, 56% and 50.5% treatment coverage in 2015 and 2016 respectively. Focus group discussions (FGDs) (n = 8) and in-depth interviews (IDIs) (n = 8) with CDDs, IDIs (n = 22) with opinion leaders and IDIs (n = 8) with health workers were conducted and the data analyzed by QSR NVIVO version 10 according to thematic areas. The results showed that based on the perceptions and experiences of the CDDs, several challenges: communities’ refusal to take the drugs; absenteeism during MDA; non-adherence to CDDs selection criteria; inadequacy in number of CDDs engaged during the campaign and training provided; insufficiency of drugs issued to CDDs; lack of CDDs supervision and low motivation negatively impact on MDA uptake. Opportunities to address the challenges included: awareness creation on MDA, health education on LF and observation of hygiene during drug administration, increased duration of awareness creation and drug administration, adherence to CDDs selection criteria and putting into consideration the vastness of an area and population density while deploying CDDs. Other opportunities include: improved CDDs training and scheduling; issuing of enough drugs to CDDs to meet the communities’ demand and improved supervision and motivation of CDDs. Addressing the challenges highlighted is an important step of maximizing MDA uptake. The opportunities presented need to be considered by the NTD program personnel, the county health personnel and the community while planning the implementation of MDA campaigns. Elephantiasis infection which is common in tropical areas is targeted for elimination globally through delivery of drugs to all populations living in areas where infections occur. Community Drug Distributors (CDDs) are persons who live in the affected communities and who volunteer themselves to distribute drugs after receiving training from the health care workers. Understanding the challenges and opportunities for improved community drug uptake from the perspectives and experiences of the CDDs is important for a successful elimination campaign. As part of a larger study to address barriers of drug uptake in Kenya, we collected qualitative data to explore the challenges and opportunities for improved drug uptake in two wards of Kilifi County. The data was collected through focus group discussions and in-depth interviews and analyzed. For drug uptake to be improved, the CDDs’ mentioned challenges related to how their selection is done, number of CDDs engaged, quality of their training, quantities of drugs issued to them, supervision and motivation that need to be addressed. The communities targeted for treatment need well scheduled health education activities on elephantiasis, awareness creation on drug distribution and drug reaction for them to understand the importance of receiving the treatment. These findings suggest the need for strong collaborations between NTD program, county health personnel and the community that are useful in the planning the implementation of successful national programs.
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Affiliation(s)
- Doris W. Njomo
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC) Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- * E-mail: ,
| | - Bridget W. Kimani
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC) Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Lydiah W. Kibe
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC) Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Collins Okoyo
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC) Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Wyckliff P. Omondi
- Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Nairobi, Kenya
| | - Hadley M. Sultani
- Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Nairobi, Kenya
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Khatri V, Chauhan N, Kalyanasundaram R. Fecundity of adult female worms were affected when Brugia malayi infected Mongolian gerbils were immunized with a multivalent vaccine (rBmHAXT) against human lymphatic filarial parasite. Acta Trop 2020; 208:105487. [PMID: 32437645 PMCID: PMC7655632 DOI: 10.1016/j.actatropica.2020.105487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/18/2020] [Accepted: 04/01/2020] [Indexed: 01/03/2023]
Abstract
A multivalent recombinant fusion protein prophylactic vaccine, rBmHAXT developed against lymphatic filariasis (LF) demonstrated over 57% protection against challenge infection in rhesus macaque model. Currently, we do not know if the rBmHAXT vaccination has any effect on adult worms and/or on the fecundity of adult female worms. Thus, the major focus of this study was to determine the effect of rBmHAXT vaccination on Brugia malayi infected mongolian gerbils. We performed two sets of experiments. In the first set of experiment, gerbils were infected with 100 B. malayi L3. After confirming the establishment of infection, four rounds of DEC treatment and rBmHAXT vaccination was given. Results showed that following vaccination with rBmHAXT, the microfilaria (Mf) count was significantly decreased in all vaccinated animals compared to controls. At the end of these experiments, we collected and counted the established adult worms. There was a 36% reduction in the recovery of adult female worms, which might account for the low Mf load in vaccinated animals. In the second set of experiments, animals were vaccinated first with rBmHAXT followed by surgically implanting adult male or female B. malayi parasites into the peritoneal cavity to determine the effect of vaccination on each sex of the parasite. Our results show that the rBmHAXT vaccination has no effect on male adult worms compared to controls. However, there was 40% reduction in the Mf load in vaccinated animals that were transplanted with adult female worms. These findings suggested that the rBmHAXT vaccination has potential damaging effect on the fecundity of adult female worms. Scanning electron microscopy studies showed cuticular damage on the surface of adult female worms. These studies thus show that the rBmHAXT vaccination in infected gerbils has partial microfilaricidal effect and potentially affect the fecundity of adult female worms.
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Affiliation(s)
- Vishal Khatri
- Department of Biomedical Sciences, University of Illinois College of Medicine, Rockford, IL, USA
| | - Nikhil Chauhan
- Department of Biomedical Sciences, University of Illinois College of Medicine, Rockford, IL, USA
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Banerjee S, Bandyopadhyay K, Khan MF, Akkilagunta S, Selvaraj K, Tripathy JP, Solanki R, Kushwaha AS, Deshmukh P. Coverage of mass drug administration for elimination of lymphatic filariasis in urban Nagpur, Central India: A mixed method study. J Family Med Prim Care 2019; 8:3009-3014. [PMID: 31681683 PMCID: PMC6820416 DOI: 10.4103/jfmpc.jfmpc_503_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/22/2019] [Accepted: 09/03/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Mass Drug Administration (MDA) coverage remains an important indicator in elimination of Lymphatic Filariasis (LF), especially in context of recent changes in programme strategies in India, such as incorporation of Ivermectin and involvement of urban Accredited Social Health Activists (ASHAs). This study aimed at assessing the coverage and compliance with MDA of Filariasis as well as exploring perspective of beneficiaries for non-consumption in selected slum area of Nagpur city. METHODS Mixed-method study design comprising of quantitative assessment of MDA coverage, followed by qualitative method to explore the reasons of non-compliance was used in selected slum areas of Nagpur city. Using cluster sampling, 240 households were selected and house-to-house visits were made to interview the eligible participants. In-depth interviews were conducted among selected non-compliant participants. STATISTICAL ANALYSIS Multivariable logistic regression analysis to identify the factors associated with non-consumption. Thematic analysis was done to obtain the reasons of non-consumption as perceived by the beneficiaries. RESULTS Among the 1096 individuals studied, distribution and consumption coverage were 55.2% and 48.5%, respectively. Effective supervised consumption was further low (28.9%). Coverage compliance gap (CCG) was 12.1%. Male sex and younger age (2-5 years) were significant socio-demographic determinants of non-consumption. No repeat visit to houses left in first round, fear of side effects, pill burden, poor understanding about the need were important reasons as revealed by qualitative inquiry. CONCLUSION Effective pre-campaign awareness, incorporation of context specific drug delivery strategies and strengthening monitoring system are essential for successful MDA implementation.
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Affiliation(s)
- Sitikantha Banerjee
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Kajari Bandyopadhyay
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Mubashshera F. Khan
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Sujiv Akkilagunta
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Kalaiselvi Selvaraj
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Jaya P. Tripathy
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Ranjan Solanki
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Arvind S. Kushwaha
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Pradeep Deshmukh
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
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Khatri V, Amdare N, Chauhan N, Togre N, Reddy MV, Hoti SL, Kalyanasundaram R. Epidemiological screening and xenomonitoring for human lymphatic filariasis infection in select districts in the states of Maharashtra and Karnataka, India. Parasitol Res 2019; 118:1045-1050. [PMID: 30666407 PMCID: PMC6401222 DOI: 10.1007/s00436-019-06205-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 01/04/2019] [Indexed: 10/27/2022]
Abstract
Lymphatic filariasis (LF) is a mosquito-transmitted tropical neglected parasitic infection that currently affects over 120 million people around the world and another 856 million people are at risk of acquiring the infection. Mass Drug Administration (MDA) spearheaded by the World Health Organization is the only current strategy to control this infection in endemic areas. In this study, we performed an epidemiological survey in select regions in the southern parts of India to determine the current status of LF infection in subjects. Night blood samples were collected from 916 subjects after proper consent and were screened for the presence of circulating microfilariae of Wuchereria bancrofti in their peripheral blood. Our results showed the presence of 51 (5.56%) cases of human LF infection in the surveyed areas including new cases for LF, which were not recorded previously. Given the presence of new cases of LF infections, we trapped mosquitoes from these regions and screened for the presence of W. bancrofti L3 specific Ssp1 DNA repeat sequences by PCR. Our results confirmed the presence of LF infection in the mosquitoes collected from six out of nine districts that we surveyed. These findings confirm active transmission of LF infection in all of the areas that we surveyed, despite several years of MDA treatment. The findings in this study suggest potential reemergence of LF infection in most of the areas we surveyed and warrants for a more stringent strategy for controlling LF in these endemic areas.
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Affiliation(s)
- Vishal Khatri
- Department of Biomedical Sciences, University of Illinois College of Medicine, Rockford, IL, USA
| | - Nitin Amdare
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Nikhil Chauhan
- Department of Biomedical Sciences, University of Illinois College of Medicine, Rockford, IL, USA
| | - Namdev Togre
- Department of Biochemistry, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
| | - Maryada V Reddy
- Department of Biochemistry, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
| | - Subhash L Hoti
- Regional Medical Research Centre, Indian Council of Medical Research, Belgaum, India
| | - Ramaswamy Kalyanasundaram
- Department of Biomedical Sciences, University of Illinois College of Medicine, Rockford, IL, USA.
- Department of Biomedical Sciences, University of Illinois College of Medicine, 1601 Parkview Avenue, Rockford, IL, 61107, USA.
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Widjanarko B, Saraswati LD, Ginandjar P. Perceived threat and benefit toward community compliance of filariasis' mass drug administration in Pekalongan district, Indonesia. Risk Manag Healthc Policy 2018; 11:189-197. [PMID: 30464659 PMCID: PMC6208933 DOI: 10.2147/rmhp.s172860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Lymphatic filariasis (LF) is a chronic infection of Brugia malayi, Brugia timori, and Wuchereria bancrofti and is a mosquito-transmitted disease. Mass drug administration (MDA) needs to be done annually to control LF and requires adherence of endemic populations to take medication properly. Maintaining high coverage of MDA is a challenge because the activity needs to be done in several years. This study would like to know the compliance of the community in taking medication during MDA periods in Pekalongan district using the health belief model (HBM) approach. PATIENTS AND METHODS Study population was people living in endemic areas in Pekalongan district, Central Java Province. This was a cross-sectional study. HBM approach was used to analyze community perceived in regard to MDA. There were six of the 19 subdistrict selected as study location, and 100 subjects were selected from each sub-district. Therefore, a total of 600 subjects participated in this study. Data were collected using the structured questionnaire. Data were analyzed quantitatively using the Chi-squared test. Multivariate analysis was used for logistic regression. RESULTS Results of this study showed that the mean age of subjects was 38.6 years and had been staying in their villages for more than 30 years. Gender, marital status, history of LF, history of LF in the family, and external cues to action did not relate to MDA compliance. Perceived susceptibility, perceived severity, perceived benefits, and perceived barriers were factors related to the compliance of MDA. After multivariate analysis, the perceived susceptibility did not have relationship with compliance. CONCLUSION This study showed HBM variables, ie, perceived susceptibility, perceived severity, perceived benefit, and perceived barrier associated with the medication adherence of LF. The role of elimination officers was important to increase community knowledge about MDA program and the benefit to control LF disease.
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Affiliation(s)
- Bagoes Widjanarko
- Doctoral Program of Public Health, Faculty of Public Health, Diponegoro University, Semarang, Indonesia
- Department of Health Promotion, Faculty of Public Health, Diponegoro University, Semarang, Indonesia
| | - Lintang Dian Saraswati
- Department of Epidemiology and Tropical Diseases, Faculty of Public Health, Diponegoro University, Semarang, Indonesia,
| | - Praba Ginandjar
- Department of Epidemiology and Tropical Diseases, Faculty of Public Health, Diponegoro University, Semarang, Indonesia,
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Chauhan N, Khatri V, Banerjee P, Kalyanasundaram R. Evaluating the Vaccine Potential of a Tetravalent Fusion Protein ( rBmHAXT) Vaccine Antigen Against Lymphatic Filariasis in a Mouse Model. Front Immunol 2018; 9:1520. [PMID: 30013570 PMCID: PMC6036175 DOI: 10.3389/fimmu.2018.01520] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/19/2018] [Indexed: 12/22/2022] Open
Abstract
Lymphatic filariasis (LF) is a tropical parasitic infection of human transmitted by mosquitoes. Chronic infection results in severe physical disability in the infected patients. Although several potential vaccine antigens were identified by several groups, there are no licensed prophylactic vaccine to date against this infection in the human. Previous attempts from our laboratory to develop a trivalent prophylactic vaccine against LF showed that >90% protection could be achieved in rodent models. However, this trivalent vaccine gave only 35% protection in non-human primates. The major focus of this study was to develop a tetravalent prophylactic vaccine (rBmHAXT) and test the vaccine potential in a mouse model. We evaluated three different adjuvant formulations; alum, glucopyranosyl lipid adjuvant in stable emulsion (GLA/SE) alum (AL019), and mannosylated chitosan (MCA) to determine the optimum adjuvant formulation for rBmHAXT. Results presented in this study show that rBmHAXT + AL019 gave the highest rate of protection (>88%) against challenge infection, compared to rBmHAXT + AL007 (79%), rBmHAXT + MCA (79%) and controls. Analysis of the immune correlates of protection showed that all three adjuvants elicited high titer of antigen-specific IgG1, IgG2a, and IgG2b antibodies. High number of IFN-γ-producing antigen-specific memory cells were generated in the vaccinated animals irrespective of the adjuvants used. Similarly, spleen cells from rBmHAXT-vaccinated animals secreted IL-4, IL-10, and IFN-γ in response to rBmHAXT suggesting the generation of a balanced Th1/Th2 response. There was also an increase in IL-17-secreting cells in rBmHAXT-vaccinated animals. These findings thus suggest that rBmHAXT + AL019 is a better prophylactic formulation for LF.
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Affiliation(s)
- Nikhil Chauhan
- Department of Biomedical Sciences, University of Illinois, Rockford, IL, United States
| | - Vishal Khatri
- Department of Biomedical Sciences, University of Illinois, Rockford, IL, United States
| | - Priyankana Banerjee
- Department of Biomedical Sciences, University of Illinois, Rockford, IL, United States
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Khatri V, Chauhan N, Vishnoi K, von Gegerfelt A, Gittens C, Kalyanasundaram R. Prospects of developing a prophylactic vaccine against human lymphatic filariasis - evaluation of protection in non-human primates. Int J Parasitol 2018; 48:773-783. [PMID: 29885437 DOI: 10.1016/j.ijpara.2018.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/29/2018] [Accepted: 04/04/2018] [Indexed: 12/30/2022]
Abstract
Lymphatic filariasis (LF) affects 120 million people around the world and another 856 million people are at risk of acquiring the infection. Mass Drug Administration (MDA) spearheaded by the World Health Organization is the only current strategy to control this infection. Recent reports suggest that despite several rounds of MDA, elimination has not been achieved and there is a need for more stringent control strategies for control of LF. An effective prophylactic vaccine combined with MDA has significant potential. Initial trials using a prophylactic trivalent recombinant Brugia malayi heat shock protein 12.6, abundant larval transcript -2 and tetraspanin large extra-cellular loop (rBmHAT) vaccine developed in our laboratory conferred only 35% protection in macaques. Therefore, the focus of the present study was to improve the current vaccine formulation to obtain better protection in non-human primates. We made two modifications to the current formulation: (i) the addition of another antigen, thioredoxin peroxidase-2 (TPX-2) to make it a tetravalent vaccine (rBmHAXT) and (ii) the inclusion of an adjuvant; AL019 (alum plus glucopyranosyl lipid adjuvant-stable emulsion) that is known to promote a balanced Th1/Th2 response. A double-blinded vaccination trial was performed with 40 macaques that were divided into three treatment groups and one control group (n = 10/group). Vaccinated animals received 4 immunisations at 1 month intervals with 150 µg/ml of rBmHAT plus alum, rBmHAT plus AL019 or rBmHAXT plus AL019. Control animals received AL019 only. All vaccinated macaques developed significant (P ≤ 0.003) titers of antigen-specific IgG antibodies (1:20,000) compared with the controls. One month after the last dose, all macaques were challenged s.c. with 130-180 B. malayi L3s. Our results showed that seven out of 10 (70%) of macaques given the improved rBmHAXT vaccine did not develop the infection compared with AL019 controls, of which seven out of 10 macaques developed the infection. Titers of antigen-specific IgG1 and IgG2 antibodies were significantly (P ≤ 0.01) higher in vaccinated animals and there was an increase in the percentage of IL-4 and IFN-γ secreting antigen-responding memory T cells. These studies demonstrated that the improved formulation (rBmHAXT plus AL019) is a promising vaccine candidate against human lymphatic filariasis.
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Affiliation(s)
- Vishal Khatri
- Department of Biomedical Sciences, University of Illinois College of Medicine, Rockford, IL, USA
| | - Nikhil Chauhan
- Department of Biomedical Sciences, University of Illinois College of Medicine, Rockford, IL, USA
| | - Kanchan Vishnoi
- Department of Surgery, University of Illinois College of Medicine, Chicago, IL, USA
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Cabral S, Bonfim C, Oliveira R, Oliveira P, Guimarães T, Brandão E, Aguiar-Santos AM, Medeiros Z. Knowledge, attitudes and perceptions regarding lymphatic filariasis: study on systematic noncompliance with mass drug administration. Rev Inst Med Trop Sao Paulo 2017; 59:e23. [PMID: 28443941 PMCID: PMC5436738 DOI: 10.1590/s1678-9946201759023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 03/31/2017] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to investigate the epidemiological characteristics, antigenic profile, perceptions, attitudes and practices of individuals who have been systematically non-compliant in mass drug administration (MDA) campaigns targeting lymphatic filariasis, in the municipality of Olinda, State of Pernambuco, Northeastern Brazil. A pretested questionnaire was used to obtain information on socioenvironmental demographics, perceptions of lymphatic filariasis and MDA, and reasons for systematic noncompliance with treatment. A rapid immunochromatographic test (ICT) was performed during the survey to screen for filariasis. It was found that the survey subjects knew about filariasis and MDA. Filariasis was identified as a disease (86.2%) and 74.4% associated it with the presence of swelling in the legs. About 80% knew about MDA, and the main source of information was healthcare workers (68.3%). For men the main reasons for systematic noncompliance with MDA were that “the individual had not received the medication” (p=0.03) and for women “the individual either feared experiencing adverse reactions”. According to the ICT, the prevalence of lymphatic filariasis was 2%. The most important causes of systematic noncompliance were not receiving the drug and fear of side-effects. For successful implementation of MDA programs, good planning, educational campaigns promoting the benefits of MDA, adoption of measures to minimize the impact of adverse effects and improvement of drug distribution logistics are needed.
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Affiliation(s)
- Silvia Cabral
- Fundação Oswaldo Cruz, Centro de Pesquisa Aggeu Magalhães, Programa de Doutorado em Saúde Pública, Pernambuco, Brazil
| | - Cristine Bonfim
- Fundação Joaquim Nabuco, Departamento de Pesquisa Social, Pernambuco, Brazil.,Universidade Federal de Pernambuco, Programa de Pós-Graduação Integrada em Saúde Coletiva, Pernambuco, Brazil
| | - Rosalira Oliveira
- Fundação Joaquim Nabuco, Departamento de Pesquisa Social, Pernambuco, Brazil
| | - Paula Oliveira
- Secretaria da Saúde de Olinda, Pernambuco, Brazil.,Fundação Oswaldo Cruz, Centro de Pesquisa Aggeu Magalhães, Departamento de Parasitologia, Pernambuco, Brazil
| | | | - Eduardo Brandão
- Fundação Oswaldo Cruz, Centro de Pesquisa Aggeu Magalhães, Departamento de Parasitologia, Pernambuco, Brazil
| | - Ana Maria Aguiar-Santos
- Fundação Oswaldo Cruz, Centro de Pesquisa Aggeu Magalhães, Departamento de Parasitologia, Pernambuco, Brazil
| | - Zulma Medeiros
- Fundação Oswaldo Cruz, Centro de Pesquisa Aggeu Magalhães, Departamento de Parasitologia, Pernambuco, Brazil.,Universidade de Pernambuco, Instituto de Ciências Biológicas, Pernambuco, Brazil
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Modi A, Gamit S, Jesalpura BS, Kurien G, Kosambiya JK. Reaching endpoints for lymphatic filariasis elimination- results from mass drug administration and nocturnal blood surveys, South Gujarat, India. PLoS Negl Trop Dis 2017; 11:e0005476. [PMID: 28369129 PMCID: PMC5391126 DOI: 10.1371/journal.pntd.0005476] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 04/13/2017] [Accepted: 03/10/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Following the World Health Assembly resolution on Elimination of lymphatic filariasis (ELF) as a public health problem by the year 2020, a Global Program (GPELF) was launched in 1997 to help endemic countries to initiate national programs. The current strategy to interrupt transmission of LF, is administration of once-yearly, single-dose, two-drug regimen (Albendazole with Diethylcarbamazine (DEC) to be used in endemic areas with the goal of reaching 65% epidemiological coverage for 4-6 years. We report findings of independent assessment from year 2010 to 2015 for last six rounds, after initial five rounds of Mass Drug Administration (MDA) since 2005 for ELF in endemic area of Gujarat. METHODS Independent assessment of MDA was performed to find coverage and compliance indicators, reasons for non-coverage and non-compliance in five Implementation Units (IUs). Pre, during and post MDA evaluations were done in three phases. The impact of MDA was measured by microfilaraemia survey. A total of eight sites, four random and four fixed sentinel sites were selected to calculate microfilaria rate (MF) per IUs per year. In years 2010 to 2015, we report results from 125,936 nocturnal blood smears and 17551 population in 120 selected clusters. Four clusters were selected per year in each of the five IUs for assessment of MDA round. RESULT Post MDA survey showed drug coverage between 81%-88% and epidemiological coverage 77%-89% across years. Main reasons for non-coverage were drug administrator related (the team did not visit or missed people) while non-compliance was population related (fear of side effects, sickness, people forgot or absent). During MDA findings show that the directly observed consumption is considerably improved from 58% in 2010 to 82% in 2015. The knowledge about benefits of drug provided also increased from 59% to 90% over the years. The current MF rate is less than one in all IUs with an overall 68% percent decrease from baseline year 2005 to year 2015. The average MF rate of Gujarat is 0.44 for year 2015. CONCLUSIONS The findings show that achieving adequate epidemiological and drug coverage is possible by actual field level operation of the program in large endemic areas. The results and feedback from independent assessment, performed regularly, could guide the policymakers and program managers for mid-term corrections and to frame strategies to enhance program. Monitoring of coverage and impact indicator together informs decisions for reaching end-point of MDA. The impact indicator- microfilaria rate in all IUs of South Gujarat Region has reached and remained less than one percent signaling end-points of MDA. Post MDA stringent monitoring in form of TAS is recommended to keep vigil on maintenance of elimination achieved.
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Affiliation(s)
- Anjali Modi
- Department of Community Medicine, Government Medical College, Surat, Gujarat, India
| | - Sukesha Gamit
- Department of Community Medicine, Government Medical College, Surat, Gujarat, India
| | - Bharat S. Jesalpura
- National Vector Borne Disease Control Department (NVBDCP), Health and Family Welfare Department, Government of Gujarat, Gandhinagar, Gujarat, India
| | - George Kurien
- National Vector Borne Disease Control Department (NVBDCP), Health and Family Welfare Department, Government of Gujarat, Gandhinagar, Gujarat, India
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Improving Coverage and Compliance in Mass Drug Administration for the Elimination of LF in Two 'Endgame' Districts in Indonesia Using Micronarrative Surveys. PLoS Negl Trop Dis 2016; 10:e0005027. [PMID: 27812107 PMCID: PMC5094770 DOI: 10.1371/journal.pntd.0005027] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 09/09/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND As the Global Programme to Eliminate Lymphatic Filariasis (LF) approaches its 2020 goal, an increasing number of districts will enter the endgame phase where drug coverage rates from mass drug administration (MDA) are used to assess whether MDA can be stopped. As reported, the gap between reported and actual drug coverage in some contexts has overestimated the true rates, thus causing premature administration of transmission assessment surveys (TAS) that detect ongoing LF transmission. In these cases, districts must continue with additional rounds of MDA. Two districts in Indonesia (Agam District, Depok City) fit this criteria-one had not met the pre-TAS criteria and the other, had not passed the TAS criteria. In both cases, the district health teams needed insight into their drug delivery programs in order to improve drug coverage in the subsequent MDA rounds. METHODOLOGY/PRINCIPAL FINDINGS To inform the subsequent MDA round, a micronarrative survey tool was developed to capture community members' experience with MDA and the social realm where drug delivery and compliance occur. A baseline survey was implemented after the 2013 MDA in endemic communities in both districts using the EPI sampling criteria (n = 806). Compliance in the last MDA was associated with perceived importance of the LF drugs for health (p<0.001); perceived safety of the LF drugs (p<0.001) and knowing someone in the household has complied (p<0.001). Results indicated that specialized messages were needed to reach women and younger men. Both districts used these recommendations to implement changes to their MDA without additional financial support. An endline survey was performed after the 2014 MDA using the same sampling criteria (n = 811). Reported compliance in the last MDA improved in both districts from 57% to 77% (p<0.05). Those who reported having ever taken the LF drug rose from 79% to 90% (p<0.001) in both sites. CONCLUSIONS/SIGNIFICANCE Micronarrative surveys were shown to be a valid and effective tool to detect operational issues within MDA programs. District health staff felt ownership of the results, implementing feasible changes to their programs that resulted in significant improvements to coverage and compliance in the subsequent MDA. This kind of implementation research using a micronarrative survey tool could benefit underperforming MDA programs as well as other disease control programs where a deeper understanding is needed to improve healthcare delivery.
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