PLoS Neglected Tropical Diseases (Mar 2021)

A multicenter, community-based, mixed methods assessment of the acceptability of a triple drug regimen for elimination of lymphatic filariasis.

  • Alison Krentel,
  • Nandha Basker,
  • Madsen Beau de Rochars,
  • Joshua Bogus,
  • Daniel Dilliott,
  • Abdel N Direny,
  • Christine Dubray,
  • Peter U Fischer,
  • Adriani Lomi Ga,
  • Charles W Goss,
  • Myra Hardy,
  • Cade Howard,
  • Purushothaman Jambulingam,
  • Christopher L King,
  • Moses Laman,
  • Jean Frantz Lemoine,
  • Shruti Mallya,
  • Leanne J Robinson,
  • Josaia Samuela,
  • Ken B Schechtman,
  • Andrew C Steer,
  • Taniawati Supali,
  • Livingstone Tavul,
  • Gary J Weil

DOI
https://doi.org/10.1371/journal.pntd.0009002
Journal volume & issue
Vol. 15, no. 3
p. e0009002

Abstract

Read online

BackgroundMany countries will not reach elimination targets for lymphatic filariasis in 2020 using the two-drug treatment regimen (diethylcarbamazine citrate [DEC] and albendazole [DA]). A cluster-randomized, community-based safety study performed in Fiji, Haiti, India, Indonesia and Papua New Guinea tested the safety and efficacy of a new regimen of ivermectin, DEC and albendazole (IDA).Methodology/principal findingsTo assess acceptability of IDA and DA, a mixed methods study was embedded within this community-based safety study. The study objective was to assess the acceptability of IDA versus DA. Community surveys were performed in each country with randomly selected participants (>14 years) from the safety study participant list in both DA and IDA arms. In depth interviews (IDI) and focus group discussions (FGD) assessed acceptability-related themes. In 1919 individuals, distribution of sex, microfilariae (Mf) presence and circulating filarial antigenemia (CFA), adverse events (AE) and age were similar across arms. A composite acceptability score summed the values from nine indicators (range 9-36). The median (22.5) score indicated threshold of acceptability. There was no difference in scores for IDA and DA regimens. Mean acceptability scores across both treatment arms were: Fiji 33.7 (95% CI: 33.1-34.3); Papua New Guinea 32.9 (95% CI: 31.9-33.8); Indonesia 30.6 (95% CI: 29.8-31.3); Haiti 28.6 (95% CI: 27.8-29.4); India 26.8 (95% CI: 25.6-28) (PConclusions/significanceIDA and DA regimens for LF elimination were highly and equally acceptable in individuals participating in the community-based safety study in Fiji, Haiti, India, Indonesia, and Papua New Guinea. Country variation in acceptability was significant. Acceptability of the professionalism of the treatment delivery was highlighted.