Individual adherence to mass drug administration in neglected tropical disease control: A probability model conditional on past behaviour

PLoS Negl Trop Dis. 2021 Jan 22;15(1):e0009112. doi: 10.1371/journal.pntd.0009112. eCollection 2021 Jan.

Abstract

We present a general framework which describes the systematic (binary) scenario of individuals either taking treatment or not for any reason, over the course of mass drug administration (MDA)-which we refer to as 'adherence' and 'non-adherence'. The probability models developed can be informed by observed adherence behaviour as well as employed to explore how different patterns influence the impact of MDA programmes, by the use of mathematical models of transmission and control. We demonstrate the interpretative value of the developed probability model employing a dataset collected in the TUMIKIA project, a randomised trial of deworming strategies to control soil-transmitted helminths (STH) by MDA conducted in coastal Kenya. We stratify our analysis by age and sex, although the framework which we introduce here may be readily adapted to accommodate other stratifications. Our findings include the detection of specific patterns of non-adherence in all age groups to varying extents. This is particularly apparent in men of ages 30+. We then demonstrate the use of the probability model in stochastic individual-based simulations by running two example forecasts for the elimination of STH transmission employing MDA within the TUMIKIA trial setting with different adherence patterns. This suggested a substantial reduction in the probability of elimination (between 23-43%) when comparing observed adherence patterns with an assumption of independence, with important implications for programmes. The results here demonstrate the considerable impact and utility of considering non-adherence on the success of MDA programmes to control neglected tropical diseases (NTDs).

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Animals
  • Child
  • Child, Preschool
  • Female
  • Helminthiasis / drug therapy*
  • Helminths / drug effects
  • Humans
  • Infant
  • Infant, Newborn
  • Kenya
  • Larva / drug effects
  • Male
  • Mass Drug Administration*
  • Middle Aged
  • Models, Theoretical
  • Neglected Diseases / drug therapy*
  • Probability
  • Soil
  • Young Adult

Substances

  • Soil