Implementation of ring strategy for community-engaged control of neurocysticercosis
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PROJECT SUMMARY Neurocysticercosis (NCC) is a common neurologic disease and a leading cause of preventable epilepsy in Asia, Africa, and Latin America. It is caused by central nervous infection with Taenia solium (the pork tapeworm). While there has been considerable recent progress in developing interventions to control transmission, programmatic adoption of these strategies has lagged far behind. There is an urgent need for sound implementation research to ensure that the most effective and practical strategies can be adopted. Over the past 7 years we developed, optimized, and tested a targeted approach known as ring treatment that takes advantage of the strong spatial clustering between human and pig hosts of this zoonotic disease. Surveillance and detection of pig infection (cysticercosis), which is visible in meat at time of slaughter and in the tongues of live pigs, leads to treatment for taeniasis (human intestinal infection) in nearby homes. This strategy provides a simple and practical method for surveillance leading to efficient treatment of those humans at highest risk of being infected with taeniasis. In a head-to-head cluster randomized trial over 2 years, ring treatment achieved the same robust level of reduced parasite transmission as mass treatment (69.3% vs. 64.7% reduction, respectively) but did so using only a small fraction of the drug (1791 vs. 11,186 doses). However, a number of barriers exist that must still be solved for ring treatment to adopted a control program. In this 5-year project, we use the Consolidated Framework for Implementation Research (CFIR) to develop an adoptable approach for ring treatment as a control program for T. solium. We first use formative evaluation with stakeholders to develop intervention protocols, then refine these protocols through a pilot study with iterative evaluation. We then evaluate ring treatment implementation as a government run and community-engaged program in a 3 year trial, following the cRE-AIM framework (cost, reach, adoption, implementation, and maintenance). We also evaluate the utility and effectiveness of integrating a new urine screening assay for cysticercosis in ring treatment intervention. Finally, we provide a series of didactic and applied implementation research training opportunities for trainees to advance capacity for implementation research in Peru.
