Perceptions and acceptability of co-administered albendazole, ivermectin and azithromycin mass drug administration, among the health workforce and recipient communities in Ethiopia

Several neglected tropical diseases (NTDs) employ mass drug administration (MDA) as part of their control or elimination strategies. This has historically required multiple distinct campaigns, each targeting one or more NTDs, representing a strain on both the recipient communities and the local health workforce implementing the distribution. We explored perceptions and attitudes surrounding combined MDA among these two groups of stakeholders. Our qualitative study was nested within a cluster randomized non-inferiority safety trial of combined ivermectin, albendazole and azithromycin MDA. Using semi-structured question guides, we conducted 16 key informant interviews with selected individuals involved in implementing MDA within the participating district. To better understand the perceptions of recipient communities, we also conducted four focus group discussions with key community groups. Individuals were selected from both the trial arm (integrated MDA) and the control arm (standard MDA) to provide a means of comparison and discussion. All interviews and focus group discussions were led by fluent Afaan oromo speakers. Interviewers transcribed and later translated all discussions into English. The study team synthesized and analyzed the results via a coding framework and software. Most respondents appreciated the time and effort saved via the co-administered MDA strategy but there were some misgivings amongst community beneficiaries surrounding pill burden. Both the implementing health work force members and beneficiaries reported refusals stemming from lack of understanding around the need for the new drug regimen as well as some mistrust of government officials among the youth. The house-to-house distribution method, adopted as a COVID-19 prevention strategy, was by far preferred by all beneficiaries over central-point MDA, and may have led to greater acceptability of co-administration. Our data demonstrate that a co-administration strategy for NTDs is acceptable to both communities and health staff. The strategy for several neglected tropical diseases is treatment of the whole community, referred to as mass drug administration. Normally these are delivered as separate rounds of treatment for each disease. This creates a burden for both the health workforce and the communities. As part of a larger study conducted in Ethiopia we used interviews and focus groups to explore perceptions and attitudes towards combined mass drug administration among both communities and health workers.Both community members and health workers appreciated the time and effort saved via combined treatment although some community members were worried about the number of pills that had to be taken. Both health workers and community members said some people declined to take part due to a lack of understanding around the need for a combined drug regimen. Delivery of the drugs house-to-house, which had been adopted as a COVID-19 prevention strategy, was preferred over delivering the treatment at a central point in the community. Overall, our study showed that combined treatment of multiple neglected tropical diseases was acceptable to both communities and health workers.