Adaptation and Evaluation of a Multi-Criteria Decision Analysis Model for Lyme Disease Prevention.

Cécile Aenishaenslin,Denise Bélanger,Lise Gern,François Milord,Pascal Michel,Jean-Philippe Waaub,Valérie Hongoh,André Ravel,Brian Stevenson

doi:10.1371/journal.pone.0135171

Abstract

Designing preventive programs relevant to vector-borne diseases such as Lyme disease (LD) can be complex given the need to include multiple issues and perspectives into prioritizing public health actions. A multi-criteria decision aid (MCDA) model was previously used to rank interventions for LD prevention in Quebec, Canada, where the disease is emerging. The aim of the current study was to adapt and evaluate the decision model constructed in Quebec under a different epidemiological context, in Switzerland, where LD has been endemic for the last thirty years. The model adaptation was undertaken with a group of Swiss stakeholders using a participatory approach. The PROMETHEE method was used for multi-criteria analysis. Key elements and results of the MCDA model are described and contrasted with the Quebec model. All criteria and most interventions of the MCDA model developed for LD prevention in Quebec were directly transferable to the Swiss context. Four new decision criteria were added, and the list of proposed interventions was modified. Based on the overall group ranking, interventions targeting human populations were prioritized in the Swiss model, with the top ranked action being the implementation of a large communication campaign. The addition of criteria did not significantly alter the intervention rankings, but increased the capacity of the model to discriminate between highest and lowest ranked interventions. The current study suggests that beyond the specificity of the MCDA models developed for Quebec and Switzerland, their general structure captures the fundamental and common issues that characterize the complexity of vector-borne disease prevention. These results should encourage public health organizations to adapt, use and share MCDA models as an effective and functional approach to enable the integration of multiple perspectives and considerations in the prevention and control of complex public health issues such as Lyme disease or other vector-borne and zoonotic diseases.

Highlights

In the context of global climate changes, zoonotic and vector-borne diseases may intensify their threat to human health [1]
The efficacy of the intervention to reduce the incidence of disseminated Lyme disease (LD) cases was added to the ‘public health’ category of criteria
The current study suggests that beyond the specificity of the multi-criteria decision aid (MCDA) models developed for Quebec and adapted for Switzerland, their general structure captures the fundamental and common issues that characterize the complexity of vector-borne disease prevention, as all criteria and most of the interventions were directly transferable from one context to the other

Summary

Introduction

In the context of global climate changes, zoonotic and vector-borne diseases may intensify their threat to human health [1]. Lyme disease (LD) is a good example of a complex disease that is affected by global changes, including climate disruption and changing landscapes [2,3,4,5]. Its main geographic distribution is Eurasia and North America. It is currently the most frequent vector-borne disease in temperate countries on Northern hemisphere with incidence rising in many of them. LD vectors have been increasingly found in new northern locations, such as in South-Eastern Canada, where Ixodes scapularis ticks have recently become established and where LD is emerging [9, 10]

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