BACKGROUND: Forest-going and other high-risk populations (HRPs) contribute to sustained malaria transmission in the Greater Mekong Subregion. New strategies to increase access to malaria services for these populations are required if the 2030 regional elimination target is to be met. This study assessed the feasibility, acceptability, and provider capacity for a peer navigator-led malaria focal test and treat (FTAT) intervention targeting HRPs in Champasak Province in southern Lao People’s Democratic Republic (Lao PDR).
METHODS: This research was conducted alongside a larger cluster-randomized controlled trial assessing the effectiveness of FTAT. Between April-November 2018, we conducted 38 interviews and 4 focus group discussions with diverse stakeholders, including HRPs, peer navigators, local health staff, and malaria officials, and 20 observations with a subset of 10 peer navigators. Using a hybrid deductive-inductive approach, data were thematically analyzed in Dedoose software and triangulated across methods, stakeholder types, and timepoints. The Consolidated Framework for Implementation Research guided the assessment, analysis, and interpretation of FTAT capacity, feasibility, and acceptability findings.
RESULTS: Peer navigators were highly capable of and confident in conducting the FTAT intervention (malaria testing, treatment, education, and interviewing), and stakeholders perceived the intervention to be largely feasible and acceptable. Reported benefits of FTAT included increased HRP access to free, on-site malaria testing and treatment; increased malaria knowledge among HRPs; peer to peer learning; and increased access to real-time data for program planning. Identified challenges included high FTAT implementation costs, poor road and travel conditions, and initial fear or reluctance among some HRPs to participate in FTAT, while high HRP cooperability and demand for FTAT were key facilitators to FTAT feasibility.
CONCLUSION: The peer navigator-led FTAT intervention is a feasible and acceptable approach to increasing access to malaria care among HRPs in southern Lao PDR. Demonstrated to be highly capable, effective, and accepted, lay or peer health workers could play an instrumental role in a broader strategy to achieve and sustain malaria elimination in the region. Adapting the intervention based on local resource availability may be required for programmatic scale-up, given the cost barrier.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/43686 |
| Date | 24 January 2022 |
| Creators | Dantzer, Emily Anne |
| Contributors | Thea, Donald M |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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