Strategies to improve treatment coverage in community-based public health programs: A systematic review of the literature

<div><p>Background</p><p>Community-based public health campaigns, such as those used in mass deworming, vitamin A supplementation and child immunization programs, provide key healthcare interventions to targeted populations at scale. However, these programs often fall short of established coverage targets. The purpose of this systematic review was to evaluate the impact of strategies used to increase treatment coverage in community-based public health campaigns.</p><p>Methodology/ principal findings</p><p>We systematically searched CAB Direct, Embase, and PubMed archives for studies utilizing specific interventions to increase coverage of community-based distribution of drugs, vaccines, or other public health services. We identified 5,637 articles, from which 79 full texts were evaluated according to pre-defined inclusion and exclusion criteria. Twenty-eight articles met inclusion criteria and data were abstracted regarding strategy-specific changes in coverage from these sources. Strategies used to increase coverage included community-directed treatment (n = 6, pooled percent change in coverage: +26.2%), distributor incentives (n = 2, +25.3%), distribution along kinship networks (n = 1, +24.5%), intensified information, education, and communication activities (n = 8, +21.6%), fixed-point delivery (n = 1, +21.4%), door-to-door delivery (n = 1, +14.0%), integrated service distribution (n = 9, +12.7%), conversion from school- to community-based delivery (n = 3, +11.9%), and management by a non-governmental organization (n = 1, +5.8%).</p><p>Conclusions/significance</p><p>Strategies that target improving community member ownership of distribution appear to have a large impact on increasing treatment coverage. However, all strategies used to increase coverage successfully did so. These results may be useful to National Ministries, programs, and implementing partners in optimizing treatment coverage in community-based public health programs.</p></div

Summary of facilitators and barriers to effective NTD integration, as reported by study participants.

<p>Summary of facilitators and barriers to effective NTD integration, as reported by study participants.</p

Study design characteristics of included articles.

<p>Study design characteristics of included articles.</p

Ten Integration Recommendations.

<p>Ten Integration Recommendations.</p

Theoretical model of NTD integration stakeholders, simplified stakeholder interest drivers, and influence on integrated delivery.

<p>Theoretical model of NTD integration stakeholders, simplified stakeholder interest drivers, and influence on integrated delivery.</p

Inclusion diagram of studies reviewed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

<p>Inclusion diagram of studies reviewed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).</p

Percent change in coverage achieved by each strategy and individual study.

<p>(IEC: information, education, and communication activities; Community: community-based delivery; ComDT: community-directed treatment).</p

Disease focus, location, and setting of included articles.

<p>Disease focus, location, and setting of included articles.</p

Summary of activities required for delivery of mass drug administration campaigns.

<p>Summary of activities required for delivery of mass drug administration campaigns.</p

Association between operational exposure variables and inappropriate antibiotic treatment in patients without a clinical indication for antibiotics.

1<p>Entomological inoculation rate.</p>2<p>Drug was only available 0–50% of all patient visits in a week.</p>3<p>Adjusted for patient gender, facility type (private or public) visited, and month of patient visit.</p