Objective 3:

Recommend a feasible and effective approach for scaling STH transmission interruption programs

The DeWorm3 trials described above are hybrid trials, in which both clinical and implementation outcomes are addressed. The primary purpose of conducting a hybrid trial is to 

1) identify opportunities to maximize program delivery while maintaining fidelity to the randomized intervention

2) contextualize clinical trial findings within the operational and health systems landscape

3) generate evidence regarding opportunities to sustain or scale-up successful MDA delivery strategies.

Led by the Clinical Trial and Implementation Science support unit at the University of Washington, a number of implementation science studies are taking place in DeWorm3 to address distinct and complementary questions.

Stakeholder mapping and accompanying network analysis are used to identify the stakeholders influencing and affected by community-wide MDA and school-age-targeted MDA. Through the characterization of stakeholder influence and relationships, opportunities for change management or facilitation of effective, sustainable improvements to delivery are identified.

Within Deworm3 qualitative research studies, individual interviews and focus groups are conducted at trial baseline, midline, and endline in order to understand barriers and facilitators to delivering community-wide MDA for STH and opportunities to optimize disease elimination campaigns more generally. In order to identify system capacity, flexibility, and commitment to potential changes in STH delivery platforms, structural readiness scores are constructed based on surveys with a wide array of stakeholders and changes in readiness are tracked over time.

Operations research is also used in DeWorm3 via intensive process mapping of activities needed to implement STH MDA with high coverage, providing evidence regarding activities that are instrumental to effective programs.

Lastly, economic evaluations are a key component of DeWorm3 implementation science research. In collaboration with the Economic Analysis support unit at the Swiss Tropical & Public Health Institute, financial and economic costs are routinely collected in trial sites to identify the relative cost-effectiveness of the DeWorm3 intervention as compared to the standard of care, both over the short-term and longer-term elimination-specific time horizons. Together, these studies contribute to the objective of identifying sustainable and scalable models for STH transmission interruption.

For more information on DeWorm3 implementation science research, the DeWorm3 implementation science protocol can be found here.