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Abstract
BackgroundThe major drawback of the community-based mass drug administration (MDA) approach against schistosomiasis is that treatment is offered blindly without testing for the targeted infection. This partly contributes to the low treatment coverage. One approach to overcome this limitation is to introduce a diagnostic component in the treatment approach. This will improve drug uptake and compliance to treatment. This study is conducted to assess the feasibility and acceptability of integrating point-of-care Circulating Cathodic Antigen (POC-CCA) test to community-based directed MDA in improving treatment coverage and compliance with treatment among adults.MethodsThis is a randomized control community trial in which 30 clusters were randomly assigned to either an intervention or control arm to evaluate two interventions on treatment coverage and compliance with treatment. In each cluster, 150 adult participants were enrolled. Community Health Workers (CHW) in both arms were trained on all aspects of praziquantel (PZQ) distribution and management of mild side effects. In the intervention arm, CHWs had additional training on how to use POC-CCA to diagnose intestinal schistosomiasis. In the intervention arm, participants were tested using POC-CCA test for presence of intestinal schistosomiasis and treated based on test results, while in the control arm, participants were treated with PZQ without testing. The primary outcome measure was the proportion of participants provided with PZQ between the two arms and geographical clusters. Secondary outcomes were prevalence of S. mansoni infection based on the POC-CCA test conducted by CHWs, ability of CHWs to use the POC-CCA test accurately and safely and community acceptability of the POC-CCA test results from CHWs. Both quantitative and qualitative techniques have been used to collect data at study endpoint.DiscussionThe study will generate evidence on the importance of integrating a diagnostic component into the community directed MDA conducted by CHWs. Findings will generate discussion on the current MDA policy and practice in Tanzania.Trial registrationPACTR201804003343404 (25/4/2018).
Highlights
The major drawback of the community-based mass drug administration (MDA) approach against schistosomiasis is that treatment is offered blindly without testing for the targeted infection
In Tanzania, because of the wide distribution of schistosomiasis, the entire population of approximately 45 million people remain at risk of the disease, and in 2012 it was estimated that 51.5% of the population was infected [2, 4]
The general objective of this study was to assess whether integrating point-of-care Circulating Cathodic Antigen rapid diagnostic testing by community health workers during a mass drug administration campaign increases uptake of praziquantel treatment among adult population
Summary
The major drawback of the community-based mass drug administration (MDA) approach against schistosomiasis is that treatment is offered blindly without testing for the targeted infection. This partly contributes to the low treatment coverage. One approach to overcome this limitation is to introduce a diagnostic component in the treatment approach This will improve drug uptake and compliance to treatment. In Tanzania, S. mansoni has remained a major public health concern, especially among communities living along and on Lake Victoria islands, in the north-western region [5, 6]. Disabling morbidities associated with schistosomiasis infection include anaemia, malnutrition, impaired development in childhood due to prolonged inflammation and hepatosplenic morbidities characterized by hepatomegaly, splenomegaly and periportal fibrosis in adulthood [7, 8]
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