From informed consent to adherence: factors influencing involvement in mass drug administration with ivermectin for malaria elimination in The Gambia.
From informed consent to adherence: factors influencing involvement in mass drug administration with ivermectin for malaria elimination in The Gambia.
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DOI：
10.1186/s12936-021-03732-z
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发表时间：
2021-04-26
期刊：
影响因子：
3
通讯作者：
Peeters Grietens K
中科院分区：
文献类型：
--
作者：
Fehr A;Nieto-Sanchez C;Muela J;Jaiteh F;Ceesay O;Maneh E;Baldeh D;Achan J;Dabira E;Conteh B;Bunders-Aelen J;Smekens T;Broekhuizen H;D'Alessandro U;Peeters Grietens K
世界卫生组织（WHO）建议考虑在即将消除疟疾的低流行地区采用大规模药物管理（MDA）来控制疟疾。然而，MDA 仍然是一项有争议的策略，因为多种个人、社会和操作因素已证明会影响其在地方层面的可接受性。由于个人和社区参与的关键指标（覆盖率、依从性和依从性）的定义不一致，情况变得更加复杂，这使人们对 MDA 对疾病控制和消除的实际和潜在流行病学影响产生怀疑。本研究旨在确定影响参与大型整群随机试验不同阶段的局限性和促成因素，该试验评估了双氢青蒿素哌喹（DP）和伊维菌素（IVM）联合使用在冈比亚疟疾传播中的效果。这项社会科学研究采用了混合方法。通过人种学方法在干预村和对照村收集定性数据，包括深度访谈（IDIs）、焦点小组讨论（FGD）以及对试验参与者和拒绝者、社区领导和现场工作人员进行的参与观察。 MDA 第一年后，在干预村进行了横断面调查。这两项研究都探讨了疟疾知识和观点、影响决策的社会动态，以及与该 MDA 相关的感知风险、负担和益处。进行了 157 次 IDI 和 11 次 FGD，调查纳入了 864 名受访者。参与的障碍和促成因素在 MDA 的不同阶段具有不同的影响。社会影响问题、对药物副作用的担忧、与疟疾相关的成本以及实施组织的可接受性等因素，对整个试验的决策过程产生了不同的影响。这项 MDA 试验的参与不是线性轨迹，而是从入组、同意药物摄入和治疗依从性等方面进行了多次重新评估。这项研究超越了通常与覆盖率和依从性相关的个人因素，发现微妙的社会动态极大地影响了试验各个阶段的决策过程。 MDA 实施战略需要考虑这些问题，并为有关报告关键有效性指标的更准确方法的讨论提供信息。在线版本包含可在 10.1186/s12936-021-03732-z 获取的补充材料。
The World Health Organization (WHO) recommends consideration of mass drug administration (MDA) for malaria control in low-endemic settings approaching elimination. However, MDA remains a controversial strategy, as multiple individual, social, and operational factors have shown to affect its acceptability at local levels. This is further complicated by inconsistent definitions of key indicators derived from individual and community involvement—coverage, adherence, and compliance—that cast doubts about the actual and potential epidemiological impact of MDA on disease control and elimination. This study aimed to identify limitations and enabling factors impacting involvement at different stages of a large cluster-randomized trial assessing the effect of combining dihydroartemisinin-piperaquine (DP) and ivermectin (IVM) in malaria transmission in The Gambia. This social science study used a mixed-methods approach. Qualitative data were collected in intervention and control villages through ethnographic methods, including in-depth interviews (IDIs), focus group discussions (FGDs), and participant observation conducted with trial participants and decliners, community leaders, and field staff. A cross-sectional survey was conducted in the intervention villages after the first year of MDA. Both strands of the study explored malaria knowledge and opinions, social dynamics influencing decision-making, as well as perceived risks, burdens, and benefits associated with this MDA. 157 IDIs and 11 FGDs were conducted, and 864 respondents were included in the survey. Barriers and enabling factors to involvement were differentially influential at the various stages of the MDA. Issues of social influence, concerns regarding secondary effects of the medication, costs associated with malaria, and acceptability of the implementing organization, among other factors, differently affected the decision-making processes throughout the trial. Rather than a linear trajectory, involvement in this MDA trial was subjected to multiple revaluations from enrolment and consent to medicine intake and adherence to treatment. This study went beyond the individual factors often associated with coverage and adherence, and found that nuanced social dynamics greatly influence the decision-making process at all phases of the trial. These issues need to be consider for MDA implementation strategies and inform discussions about more accurate ways of reporting on critical effectiveness indicators. The online version contains supplementary material available at 10.1186/s12936-021-03732-z.
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影响因子：
5.4
作者：
Kingori, Patricia;Gerrets, Rene
通讯作者：
Gerrets, Rene
影响因子：
3
作者：
Adhikari B;James N;Newby G;von Seidlein L;White NJ;Day NP;Dondorp AM;Pell C;Cheah PY
通讯作者：
Cheah PY
影响因子：
3.2
作者：
Kamga GR;Dissak-Delon FN;Nana-Djeunga HC;Biholong BD;Ghogomu SM;Souopgui J;Kamgno J;Robert A
通讯作者：
Robert A
影响因子：
5.7
作者：
Alout H;Foy BD
通讯作者：
Foy BD
影响因子：
1.7
作者：
Dabira ED;Soumare HM;Lindsay SW;Conteh B;Ceesay F;Bradley J;Kositz C;Broekhuizen H;Kandeh B;Fehr AE;Nieto-Sanchez C;Ribera JM;Peeters Grietens K;Smit MR;Drakeley C;Bousema T;Achan J;D'Alessandro U
通讯作者：
D'Alessandro U