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Article ; Online: A participatory approach to identifying gaps in and recommendations for STI and PrEP clinical services in Pierce County, Washington.

Zinsli, Kaitlin / Means, Arianna Rubin / Barbee, Lindley A / Rodriguez, Evelyn Manley / Kerani, Roxanne P

2024

Abstract: Background: Pierce County, Washington has a high burden of sexually transmitted infections (STI) relative to Washington State and the United States. We used a participatory approach to identify gaps in STI and PrEP service provision in Pierce County and ...

Abstract	Background: Pierce County, Washington has a high burden of sexually transmitted infections (STI) relative to Washington State and the United States. We used a participatory approach to identify gaps in STI and PrEP service provision in Pierce County and generate recommendations to address these gaps. Methods: In collaboration with the Tacoma-Pierce County Health Department (TPCHD), we conducted 14 key informant interviews with local STI/PrEP providers from varied clinical settings. Using rapid qualitative analysis, we identified key gaps and strengths in service provision. Local, state and national HIV/STI subject matter experts (SMEs) prioritized the gaps and recommendations to address them via an online survey. Results: The primary six gaps ranked by SMEs (N = 32) in order of importance included: 1) inadequate availability of STI and PrEP services, 2) lack of awareness of STI and PrEP services, 3) need for free/low cost STI and PrEP care, 4) need for stronger relationships among providers and TPCHD, 5) reduced accessibility related to geographically distributed population and centralized services, and 6) frequent referrals pose a service barrier. SMEs prioritized recommendations for each gap as follows: 1) create an STI specialty clinic, 2) implement an STI/PrEP service availability outreach campaign, 3) strengthen referral relationships between TPCHD and free/ low-cost providers, 4) develop a provider support network, 5) create a mobile STI clinic, and 6) develop an STI specialty clinic. Conclusions: STI specialty clinics were prioritized by SMEs to improve access to STI and PrEP care in Pierce County, and to serve as a resource for local providers.
Language	English
Publishing date	2024-02-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	435191-5
ISSN	1537-4521 ; 0148-5717
ISSN (online)	1537-4521
ISSN	0148-5717
DOI	10.1097/OLQ.0000000000001961
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Article ; Online: Participatory development of a target policy profile to support soil-transmitted helminth elimination.

Means, Arianna Rubin / List, Kellie / Roll, Amy / Gwayi-Chore, Marie-Claire / Dolley, Shawn / Schünemann, Holger J / Norman, Thea C / Walson, Judd L

Frontiers in health services

2024 Volume 3, Page(s) 1310694

Abstract: Introduction: Soil-transmitted helminths (STH) are parasitic worms that infect nearly a quarter of the world's population, particularly those living in communities without access to adequate water, sanitation, and housing. Emerging evidence suggests ... ...

Abstract	Introduction: Soil-transmitted helminths (STH) are parasitic worms that infect nearly a quarter of the world's population, particularly those living in communities without access to adequate water, sanitation, and housing. Emerging evidence suggests that it may be possible to interrupt transmission of STH by deworming individuals of all ages via community-wide MDA (cMDA), as opposed to only treating children and other focal populations. Transitioning from a policy of STH control to STH elimination in targeted areas would require a fundamental shift in STH policy and programming. This policy change would require updated guidance to support countries as they adapt their current approaches for STH surveillance, supply chain management, community mobilization, and core programmatic activities in pursuit of STH elimination. There is an opportunity to engage with key stakeholders, such as program implementers and implementation partners, to understand what evidence they need to confidently adopt a new policy guideline and to deliver guideline adherent management at scale. Methods: We aimed to engage with STH stakeholders to develop a Target Policy Profile (TPoP), a single document that describes optimal characteristics and evidence requirements that STH stakeholders prioritized in future potential STH transmission interruption efforts. Steps in TPoP development included a scoping review and key informant interviews (KIIs), which were used to design a two-stage Delphi technique to identify and verify TPoP components. Results: The scoping review resulted in 25 articles, and 8 experts participated in KII's. Twenty respondents completed the first Delphi survey and 10 respondents completed the second. This systematic effort resulted in a net of 3 key information domains (background/context, clinical considerations, and implementation considerations) encompassing 24 evidence categories (examples include evidence regarding safety and adverse events, implementation feasibility, or evidence dissemination). For each evidence category, STH stakeholders reviewed, endorsed, or revised a range of options for how the evidence could be presented. Discussion: This information can be used by guideline committees or global policy makers prior to convening guideline advisory groups. The TPoP tool may also speed the process of stakeholder consensus building around guidelines, accelerating progress towards implementing evidence-based policy at scale.
Language	English
Publishing date	2024-01-19
Publishing country	Switzerland
Document type	Journal Article
ISSN	2813-0146
ISSN (online)	2813-0146
DOI	10.3389/frhs.2023.1310694
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Article ; Online: Soil-transmitted helminth surveillance in Benin: A mixed-methods analysis of factors influencing non-participation in longitudinal surveillance activities.

Murphy, Emma / Togbevi, Innocent Comlanvi / Ibikounlé, Moudachirou / Avokpaho, Euripide Fga / Walson, Judd L / Means, Arianna Rubin

PLoS neglected tropical diseases

2023 Volume 17, Issue 1, Page(s) e0010984

Abstract: Background: Despite the significant success of deworming programs in reducing morbidity due to soil-transmitted helminth (STH) infections globally, efforts to achieve elimination of STH as a public health problem or to potentially interrupt transmission ...

Abstract	Background: Despite the significant success of deworming programs in reducing morbidity due to soil-transmitted helminth (STH) infections globally, efforts to achieve elimination of STH as a public health problem or to potentially interrupt transmission will require improving and intensifying surveillance. However, non-participation in surveillance threatens the ability of programs to adequately monitor program status and limited research has been conducted to investigate drivers of non-participation in stool-based surveillance. Methodology/principal findings: This mixed-methods exploratory sequential study took place in Comé, Benin in association with the DeWorm3 Project. Six focus group discussions were conducted with individuals invited to participate in annual DeWorm3 stool surveillance. Thematic analysis was used to identify facilitators and barriers to participation and inform the quantitative analysis. A mixed-effects logistic regression model was built using baseline DeWorm3 survey data to identify factors associated with non-participation. Qualitative and quantitative findings were merged for interpretation. Among the 7,039 individuals invited to participate in baseline stool surveillance, the refusal rate was 8.1%. Qualitative themes included: community members weighing community-level benefits against individual-level risks, circulating rumors about misuse of stool samples, interpersonal communication with field agents, and cultural norms around handling adult feces. The quantitative analysis demonstrated that adults were significantly less likely to provide a stool sample than school-aged children (OR:0.69, 95%CI: 0.55-0.88), a finding that converged with the qualitative results. Individuals from areas in the highest quartile of population density were more likely to refuse to participate (OR:1.71, 95%CI:1.16-2.52). Several variables linked to community-affinity aligned with qualitative results; residing mainly in the community (OR:0.36, 95%CI:0.20-0.66) and having lived in the community for more than 10 years (OR:0.82, 95%CI:0.54-1.25) decreased likelihood of refusal. Conclusions/significance: Optimizing STH surveillance will require that programs reimagine STH surveillance activities to address community concerns and ensure that no subpopulations are inadvertently excluded from surveillance data.
MeSH term(s)	Child ; Animals ; Humans ; Soil ; Benin/epidemiology ; Prevalence ; Helminths ; Helminthiasis/epidemiology ; Helminthiasis/prevention & control ; Feces
Chemical Substances	Soil
Language	English
Publishing date	2023-01-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2429704-5
ISSN	1935-2735 ; 1935-2735
ISSN (online)	1935-2735
ISSN	1935-2735
DOI	10.1371/journal.pntd.0010984
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Article ; Online: Monitoring and evaluating the implementation of essential packages of health services

Karl Blanchet / David Watkins / Solomon Tessema Memirie / Ala Alwan / Muhammad Khalid / Arianna Rubin Means / Kristen Danforth / Ahsan Maqbool Ahmad

BMJ Global Health, Vol 8, Iss Suppl

2023 Volume 1

Keywords	Medicine (General) ; R5-920 ; Infectious and parasitic diseases ; RC109-216
Language	English
Publishing date	2023-03-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Monitoring and evaluating the implementation of essential packages of health services.

Danforth, Kristen / Ahmad, Ahsan Maqbool / Blanchet, Karl / Khalid, Muhammad / Means, Arianna Rubin / Memirie, Solomon Tessema / Alwan, Ala / Watkins, David

BMJ global health

2023 Volume 8, Issue Suppl 1

Abstract: Essential packages of health services (EPHS) are a critical tool for achieving universal health coverage, especially in low-income and lower middle-income countries. However, there is a lack of guidance and standards for monitoring and evaluation (M&E) ... ...

Abstract	Essential packages of health services (EPHS) are a critical tool for achieving universal health coverage, especially in low-income and lower middle-income countries. However, there is a lack of guidance and standards for monitoring and evaluation (M&E) of EPHS implementation. This paper is the final in a series of papers reviewing experiences using evidence from the Disease Control Priorities, third edition publications in EPHS reforms in seven countries. We assess current approaches to EPHS M&E, including case studies of M&E approaches in Ethiopia and Pakistan. We propose a step-by-step process for developing a national EPHS M&E framework. Such a framework would start with a theory of change that links to the specific health system reforms the EPHS is trying to accomplish, including explicit statements about the 'what' and 'for whom' of M&E efforts. Monitoring frameworks need to consider the additional demands that could be placed on weak and already overstretched data systems, and they must ensure that processes are put in place to act quickly on emergent implementation challenges. Evaluation frameworks could learn from the field of implementation science; for example, by adapting the Reach, Effectiveness, Adoption, Implementation and Maintenance framework to policy implementation. While each country will need to develop its own locally relevant M&E indicators, we encourage all countries to include a set of core indicators that are aligned with the Sustainable Development Goal 3 targets and indicators. Our paper concludes with a call to reprioritise M&E more generally and to use the EPHS process as an opportunity for strengthening national health information systems. We call for an international learning network on EPHS M&E to generate new evidence and exchange best practices.
MeSH term(s)	Humans ; Ethiopia ; Health Policy ; Health Services ; National Health Programs/organization & administration ; Pakistan ; Health Care Reform ; Health Services Research
Language	English
Publishing date	2023-03-28
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2022-010726
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Article ; Online: Perceptions Associated with Noncompliance to Community-Wide Mass Drug Administration for Soil-Transmitted Helminths.

Sindhu, Kulandaipalayam Natarajan / Aruldas, Kumudha / Kaliappan, Saravanakumar Puthupalayam / Mahendran, Elavarasan / Walson, Judd L / Means, Arianna Rubin / Ajjampur, Sitara Swarna Rao

The American journal of tropical medicine and hygiene

2023 Volume 109, Issue 4, Page(s) 830–834

Abstract: Mass drug administration (MDA) is a key strategy for the control of soil-transmitted helminths (STHs). Within MDA programs, poor and non-random compliance threaten successful control of STHs. A case-control study was conducted comparing perceptions among ...

Abstract	Mass drug administration (MDA) is a key strategy for the control of soil-transmitted helminths (STHs). Within MDA programs, poor and non-random compliance threaten successful control of STHs. A case-control study was conducted comparing perceptions among non-compliant participants with compliant participants during a community-wide MDA (cMDA) with albendazole in southern India. Common reasons cited for non-compliance were that the individual was not infected with STH (97.4%), the perception that he/she was healthy (91%), fear of side-effects (12.8%), and dislike of consuming tablets (10.3%). Noncompliance was associated with poor awareness of intestinal worms (odds ratio [OR]: 9.63, 95% CI: 2.11-43.84), the perception that cMDA was only required for those with worms (OR: 2.14, 95% CI: 1.06-4.36), and the perception that the drug is not safe during pregnancy (OR: 2.19, 95% CI: 1.18-4.07) or when on concomitant medications (OR: 3.14, 95% CI: 1.38-7.15). Understanding of perceptions driving noncompliance can provide valuable insights to optimize participation during MDA for STHs.
MeSH term(s)	Female ; Humans ; Animals ; Mass Drug Administration ; Soil/parasitology ; Case-Control Studies ; Helminthiasis/drug therapy ; Helminthiasis/prevention & control ; Helminthiasis/parasitology ; Helminths ; Prevalence ; Anthelmintics/therapeutic use
Chemical Substances	4-((2-chloroethyl)(2-mesyloxyethyl)amino)benzoylglutamic acid (122665-73-0) ; Soil ; Anthelmintics
Language	English
Publishing date	2023-08-21
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2942-7
ISSN	1476-1645 ; 0002-9637
ISSN (online)	1476-1645
ISSN	0002-9637
DOI	10.4269/ajtmh.23-0176
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Article ; Online: Rapid ethnography and participatory techniques increase onchocerciasis mass drug administration treatment coverage in Benin: a difference-in-differences analysis.

Means, Arianna Rubin / Sambiéni, N'koué Emmanuel / Avokpaho, Euripide / Monra, Abdoulaye Benon / Kpatinvoh, Fifamè Aubierge Eudoxie / Bardosh, Kevin / Ibikounlé, Moudachirou

Implementation science communications

2023 Volume 4, Issue 1, Page(s) 45

Abstract: Background: Onchocerciasis, a neglected tropical disease (NTD) that causes blindness, is controlled via mass drug administration (MDA) where entire endemic communities are targeted with preventative chemotherapeutic treatment. However, in many settings, ...

Abstract	Background: Onchocerciasis, a neglected tropical disease (NTD) that causes blindness, is controlled via mass drug administration (MDA) where entire endemic communities are targeted with preventative chemotherapeutic treatment. However, in many settings, MDA coverage remains low. The purpose of this project was to determine if engaging communities in the development of implementation strategies improves MDA coverage. Methods: This study took place in an intervention and a control commune in Benin, West Africa. We conducted rapid ethnography in each commune to learn about community member perceptions of onchocerciasis, MDA, and opportunities to increase MDA coverage. Findings were shared with key stakeholders and a structured nominal group technique was used to derive implementation strategies most likely to increase treatment coverage. The implementation strategies were delivered prior to and during onchocerciasis MDA. We conducted a coverage survey within 2 weeks of MDA to determine treatment coverage in each commune. A difference-in-differences design was used to determine if the implementation package effectively increased coverage. A dissemination meeting was held with the NTD program and partners to share findings and determine the perceived acceptability, appropriateness, and feasibility of implementing rapid ethnography as part of routine program improvement. Results: During rapid ethnography, key barriers to MDA participation included trust in community drug distributors, poor penetration of MDA programs in rural or geographically isolated areas, and low demand for MDA among specific sub-populations driven by religious or socio-cultural beliefs. Stakeholders developed a five-component implementation strategy package, including making drug distributor trainings dynamic, redesigning distributor job aids, tailoring community sensitization messages, formalizing supervision, and preparing local champions. After implementing the strategy package, MDA coverage increased by 13% (95% CI: 11.0-15.9%) in the intervention commune relative to the control commune. Ministry of Health and implementing partners found the approach to be largely acceptable and appropriate; however, there was mixed feedback regarding the feasibility of future implementation of rapid ethnography. Conclusions: Implementation research conducted in Benin, and indeed throughout sub-Saharan Africa, is often implemented in a top-down manner, with both implementation determinants and strategies derived in the global North. This project demonstrates the importance of participatory action research involving community members and implementers to optimize program delivery.
Language	English
Publishing date	2023-04-26
Publishing country	England
Document type	Journal Article
ISSN	2662-2211
ISSN (online)	2662-2211
DOI	10.1186/s43058-023-00423-5
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Article ; Online: Optimising scale-up for public health impact: a multimethod implementation science research protocol to improve infant health outcomes in Ethiopia.

Hakizimana, Dieudonne / Shitu, Kegnie / Rankin, Katherine C / Alemie, Getahun A / Walson, Judd / Guthrie, Brandon L / Means, Arianna Rubin

BMJ open

2023 Volume 13, Issue 11, Page(s) e075817

Abstract: Introduction: Child mortality rates remain high in sub-Saharan Africa, including Ethiopia. We are conducting a cluster randomised control trial in the Gondar zone of the Amhara region to determine the impact of pairing Orthodox priests with community ... ...

Abstract	Introduction: Child mortality rates remain high in sub-Saharan Africa, including Ethiopia. We are conducting a cluster randomised control trial in the Gondar zone of the Amhara region to determine the impact of pairing Orthodox priests with community health workers, known locally as the Health Development Army (HDA), on newborns' nutritional status, early illness identification and treatment, and vaccination completeness.Ensuring intervention efficacy with scientific rigour is essential, but there are often delays in adopting evidence into policy and programmes. Here, we present a protocol for conducting parallel implementation research alongside an efficacy study to understand intervention implementability and scalability. This will help develop a scale-up strategy for effective elements of the intervention to ensure rapid implementation at scale. Methods and analysis: We will conduct a stakeholder analysis of key implementation stakeholders and readiness surveys to assess their readiness to scale up the intervention. We will conduct semistructured interviews and focus group discussions with stakeholders, including HDA members, health workers, Orthodox priests, and caregivers, to determine the core intervention elements that need to be scaled, barriers and facilitators to scaling up the intervention in diverse sociocultural settings, as well as the human and technical requirements for national and regional implementation. Finally, to determine the financial resources necessary for sustaining and scaling the intervention, we will conduct activity-based costing to estimate implementation costs from the provider's perspective. Ethics and dissemination: The study received approval from the University of Gondar Institutional Review Board (approval no: VP/RTT/05/1030/2022) and the University of Washington Human Subjects Division (approval no: STUDY00015369). Participants will consent to participate. Results will be disseminated through workshops with stakeholders, local community meetings, presentations at local and international conferences, and journal publications. The study will provide evidence for factors to consider in developing a scale-up strategy to integrate the intervention into routine health system practices.
MeSH term(s)	Child ; Humans ; Infant ; Infant, Newborn ; Ethiopia ; Public Health ; Implementation Science ; Nutritional Status ; Outcome Assessment, Health Care ; Randomized Controlled Trials as Topic
Language	English
Publishing date	2023-11-27
Publishing country	England
Document type	Clinical Trial Protocol ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2023-075817
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Article ; Online: Adolescents' Perspective Regarding a Community-Wide Mass Drug Administration Program for Soil-Transmitted Helminths in India.

Aruldas, Kumudha / Johnson, Jabaselvi / Saxena, Malvika / Titus, Angelin / Roll, Amy / Ramesh, Rohan Michael / Walson, Judd L / Means, Arianna Rubin / Ajjampur, Sitara Swarna Rao

The American journal of tropical medicine and hygiene

2024 Volume 110, Issue 4, Page(s) 681–686

Abstract: This study was undertaken to understand the perspective of adolescents in endemic communities of India regarding soil-transmitted helminth (STH) infections and community-wide mass drug administration (cMDA). A multicountry community-based cluster- ... ...

Abstract	This study was undertaken to understand the perspective of adolescents in endemic communities of India regarding soil-transmitted helminth (STH) infections and community-wide mass drug administration (cMDA). A multicountry community-based cluster-randomized trial, the Deworm3 trial, tested the feasibility of interrupting STH transmission with cMDA, where all individuals aged 1-99 are treated empirically with albendazole. Using a guideline based on the Consolidated Framework for Implementation Research, eight focus group discussions were conducted among 57 adolescents from the trial site in India and analyzed on ATLAS.ti 8.0 software using an a priori thematic codebook. Adolescents believed that adults could be a source of STH infection because they were not routinely dewormed like the children through the national deworming program. Perceived benefits of cMDA for all were better health and increased work efficiency. Perceived barriers to adults' participation in cMDA was their mistrust about the program, fear of side effects, perceived low risk of infection, and absence during drug distribution. To encourage adult participation in cMDAs, adolescents suggested community outreach activities, engaging village influencers and health workers, and tailoring drug distribution to when adults would be available. Adolescents were confident in their ability to be change agents within their households for treatment compliance. Adolescents provided insights into potential barriers and solutions to improve adult participation in cMDA, identified best practices of cMDA delivery, and suggested that they have unique roles as change agents to increase their household participation in cMDA.
MeSH term(s)	Adult ; Child ; Animals ; Humans ; Adolescent ; Mass Drug Administration ; Soil/parasitology ; Helminths ; Helminthiasis/drug therapy ; Helminthiasis/epidemiology ; Helminthiasis/prevention & control ; India/epidemiology ; Anthelmintics/therapeutic use ; Prevalence ; Glutamates ; Nitrogen Mustard Compounds
Chemical Substances	Soil ; 4-((2-chloroethyl)(2-mesyloxyethyl)amino)benzoylglutamic acid (122665-73-0) ; Anthelmintics ; Glutamates ; Nitrogen Mustard Compounds
Language	English
Publishing date	2024-03-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2942-7
ISSN	1476-1645 ; 0002-9637
ISSN (online)	1476-1645
ISSN	0002-9637
DOI	10.4269/ajtmh.23-0676
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Article ; Online: Soil-transmitted helminth surveillance in Benin

Emma Murphy / Innocent Comlanvi Togbevi / Moudachirou Ibikounlé / Euripide Fga Avokpaho / Judd L Walson / Arianna Rubin Means

PLoS Neglected Tropical Diseases, Vol 17, Iss 1, p e

A mixed-methods analysis of factors influencing non-participation in longitudinal surveillance activities.

2023 Volume 0010984

Abstract: Background Despite the significant success of deworming programs in reducing morbidity due to soil-transmitted helminth (STH) infections globally, efforts to achieve elimination of STH as a public health problem or to potentially interrupt transmission ... ...

Abstract	Background Despite the significant success of deworming programs in reducing morbidity due to soil-transmitted helminth (STH) infections globally, efforts to achieve elimination of STH as a public health problem or to potentially interrupt transmission will require improving and intensifying surveillance. However, non-participation in surveillance threatens the ability of programs to adequately monitor program status and limited research has been conducted to investigate drivers of non-participation in stool-based surveillance. Methodology/principal findings This mixed-methods exploratory sequential study took place in Comé, Benin in association with the DeWorm3 Project. Six focus group discussions were conducted with individuals invited to participate in annual DeWorm3 stool surveillance. Thematic analysis was used to identify facilitators and barriers to participation and inform the quantitative analysis. A mixed-effects logistic regression model was built using baseline DeWorm3 survey data to identify factors associated with non-participation. Qualitative and quantitative findings were merged for interpretation. Among the 7,039 individuals invited to participate in baseline stool surveillance, the refusal rate was 8.1%. Qualitative themes included: community members weighing community-level benefits against individual-level risks, circulating rumors about misuse of stool samples, interpersonal communication with field agents, and cultural norms around handling adult feces. The quantitative analysis demonstrated that adults were significantly less likely to provide a stool sample than school-aged children (OR:0.69, 95%CI: 0.55-0.88), a finding that converged with the qualitative results. Individuals from areas in the highest quartile of population density were more likely to refuse to participate (OR:1.71, 95%CI:1.16-2.52). Several variables linked to community-affinity aligned with qualitative results; residing mainly in the community (OR:0.36, 95%CI:0.20-0.66) and having lived in the community for more than ...
Keywords	Arctic medicine. Tropical medicine ; RC955-962 ; Public aspects of medicine ; RA1-1270
Subject code	360 ; 310
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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