Identifying opportunities to optimize mass drug administration for soil-transmitted helminths: a visualization and descriptive analysis using in-depth process mapping

Abstract

Control of soil-transmitted helminths (STH) requires mass drug administration (MDA) with deworming medications to children and other high-risk groups. Recent evidence suggests that it may be possible to interrupt transmission of STH by deworming individuals of all ages via community-wide MDA. However, the impact of school-based and community-wide MDA programs is predicated upon achieving high treatment coverage. In this study, we used process mapping, an operational research methodology, to describe the activities required for effective implementation of school-based and community-wide MDA with high coverage in 18 heterogenous areas and over three years in Benin, India and Malawi. We found that implementation of community-wide MDA requires more distinct activities than school-based MDA. Community-wide MDA activities were also adapted more often, likely because new “start-up” activities were required as compared to standard of care implementation that had already been adapted over time. Many activities across MDA platforms were not implemented according to their planned timelines, but these deviations were often purposeful to improve implementation efficiency or effectiveness. Visualized process maps were created by stakeholders in each geographic area, providing a shared vision of the implementation process. Process maps can be used to optimize MDA for high coverage by identifying potential bottlenecks and unnecessary activities, and for tracking adaptations over time. Process mapping could be deployed to support a transition from a strategy of school-based STH control to community-wide transmission interruption, and potentially for integration with other community-based programs.