Introduction: The World Health Organization resolved to eliminate lymphatic filariasis (LF), a severely disfiguring and debilitating mosquito-borne infection, as a public health problem by the year 2020 through a two-pronged approach: interrupting transmission through the mass drug administration (MDA) and alleviating the suffering of individuals already impacted by lymphatic filariasis disease through morbidity management and disability prevention (MMDP). While some national programmes have successfully met WHO targets, many continue to face challenges delivering quality interventions that lead to high community compliance. Programmes lack the tools to easily and rapidly understand the factors that promote or inhibit delivery and community uptake of interventions.
Objectives: The overarching aim of this research is to improve the body of evidence on approaches to improve quality of LF interventions. It aims to assess a novel tool to identify and target psychosocial factors influencing MDA compliance (objective 1) and new strategies to improve MDA service delivery using health systems research principals (objective 2). Further, it aims to assess the quality of MMDP interventions for LF (objective 3).
Methods: For objective 1, we will use a mixed methods approach to determine how psychosocial factors are associated with MDA compliance in Indonesia. Hypothesized behavioural factors will be identified based on a risks, attitudes, norms, abilities, and self-efficacy (RANAS) model, which will be further explored in focus group discussions. Cross-sectional surveys will be used to determine if differences in RANAS psychosocial factors can be detected between MDA compliers and non-compliers, analysed with mixed regression models. For objective 2, we will apply a health systems research framework to understand and improve MDA delivery in Haiti. First, we will use business process modelling to conceptualize and model MDA procedures. Second, we will assess the impact of microplanning on volunteer engagement and performance. Finally, for objective 3, we will use a Delphi methodology to gain consensus on indicators to be used to develop a tool to measure quality of MMDP services. These measures will be used in assessing the quality of MMDP services at health facilities in Vietnam.
Relevance: With 2020 LF elimination targets looming, novel approaches ensuring availability and access to quality interventions become increasingly crucial. This work will fills key evidence gaps in identifying and addressing factors influencing community MDA compliance, improving approaches for programmes to deliver MDA medications tailored to local settings, and assessing the quality of MMDP services at the health-facility level.