Coverage evaluation of mass drug administration with triple drug regimen in an evaluation unit in Nagpur district of Maharashtra, India.

Background: Triple drug regimen (IDA; Ivermectin, Diethylcarbamazine, Albendazole) recommended for accelerating elimination of lymphatic filariasis was launched in India in December 2018. Nagpur district in Maharashtra was one of the first five districts where this strategy was introduced. The National Vector Borne Disease Control Programme (NVBDCP) at the district reported ~85.0% treatment coverage in the first round of mass drug administration (MDA) with IDA implemented in EU-2 in Nagpur district in January 2019. As per the national guideline, a coverage evaluation survey was carried out and both quantitative and qualitative data were collected to assess the treatment coverage, the level of community preparation and identify the gaps, if any, for improvement. Methodology: A Coverage Evaluation Survey (CES) following the WHO recommended protocol was conducted in one of the two evaluation units (EU-2) in Nagpur district in March 2019. Coverage Sample Builder (CSB) V2.9 tool was used to calculate the sample size, select sites and estimate drug coverage. The CSB tool followed a two-stage cluster sampling procedure to select 30 primary sampling units (ward/village as a cluster) and a list of random numbers for selecting households (HHs) in each cluster. The results were analyzed for operational indicators. Stata ver. 14.0 software was used to construct the 95% confidence limits accounting for clustering. Results: A total of 1601 individuals aged 5–85 years of both gender from 328 HHs were surveyed from the 30 randomly selected clusters in EU-2. The mean age was 33.8±17.6 years. Among the surveyed population, 78.0% received the drugs (programme reach) and 66.1% consumed the drugs (survey coverage). Survey coverage was significantly higher in rural (82.6%) than in urban (59.4%) and peri-urban (58.6%) areas (P<0.001). Directly observed treatment (DOT) among the surveyed population was 51.6%. Adverse events were reported among 6.9% respondents who reported to have consumed the drugs. Conclusion: The IDA based MDA strategy could achieve just the required level of treatment coverage (~65%) in EU-2, Nagpur district, which had previously undergone several rounds of DA-MDAs (Diethylcarbamazine, Albendazole). Having achieved an effective treatment coverage of >80% in rural areas, the coverage in urban and peri-urban areas need to be improved in order to attain the impact of IDA-MDA. It is imperative to strengthen drug delivery and community preparation activities along with improved DOT especially in urban and peri-urban areas to achieve the required level of treatment coverage. Addition of ivermectin did not have any additional perceived adverse events. Author summary: Government of India implemented triple drug regimen for mass drug administration (IDA-MDA) in selected districts from December 2018 to accelerate lymphatic filariasis elimination in the country. Nagpur district in state of Maharashtra, India was one of the five districts where this strategy was first implemented in January 2019 and the reported treatment coverage in one of the evaluation units in the district, EU-2 was 85.0%. This district had previously completed thirteen rounds of DA-MDA till the year 2017. TAS carried out in 2016 showed that the district did not reach elimination level, CFA < 2.0% in children aged 6–7 years. A coverage evaluation survey was carried out in EU-2 following the first round of IDA-MDA and both quantitative and qualitative data was collected to assess the treatment coverage, the level of community preparation and identify the gaps, if any, for improvement. Among the surveyed population (1601), 78.0% received the drugs (programme reach) and 66.1% consumed the drugs (survey coverage). The study showed an effective treatment coverage above 65% in rural areas and a sub-optimal coverage in urban/peri-urban areas (≤65%). There exists a challenge in achieving an effective coverage in urban and peri-urban areas with the new treatment regimen. Appropriate strategies are necessary to improve the treatment coverage in all the areas so as to achieve the elimination target in the evaluation unit. Only 51.6% DOT was observed which needs to be improved. [ABSTRACT FROM AUTHOR]