Percentage of publications by NTD.

<p>Percentage of publications by NTD.</p

Review of the factors influencing the motivation of community drug distributors towards the control and elimination of neglected tropical diseases (NTDs)

<div><p>Background</p><p>Community drug distributors or neglected tropical disease (NTD) volunteers have played a crucial role in ensuring the success of mass drug administration (MDA) programs using preventive chemotherapy (PC) for lymphatic filariasis, onchocerciasis, schistosomiasis, trachoma and soil transmitted helminths. In recent years however, a noticeable decline in motivation of some of these volunteers has been perceived, potentially negatively impacting the success of these programs. Potential hypotheses for this change in motivation include the long duration of many MDA programs, the change in sociocultural environments as well as the changes to the programs over time. This literature review identifies factors that affect NTD volunteer performance and motivation, which may be used to influence and improve future programming.</p><p>Methodology/Principal findings</p><p>A systematic search was conducted to identify studies published between January 1995 and September 2016 that investigate factors pertaining to volunteer motivation and performance in NTD drug distribution programs. Searches from several databases and grey literature yielded 400 records, of which 28 articles from 10 countries met the inclusion criteria. Quality assessment of studies was performed using the Critical Appraisal Skills Programme(CASP) checklist. Data pertaining to motivation, performance, retention and satisfaction was extracted and examined for themes. Recurring themes in the literature included monetary and material incentives, intrinsic motivation, gender, cost to participate, and health systems and community support. Of these, community support and the health system were found to be particularly impactful. Very few studies were found to explicitly look at novel incentives for volunteers and very few studies have considered the out of pocket and opportunity costs that NTD volunteers bear carrying out their tasks.</p><p>Conclusions/Significance</p><p>There is currently great interest in incorporating more attractive incentive schemes for NTD volunteers. However, our results show that the important challenges that volunteers face (cultural, health systems, financial and community related) may have less to do with financial incentives and may actually have a larger impact on their motivation than has previously been understood. Further integration of NTD programs into existing health systems is expected to improve the NTD volunteer working environment. Relevant community engagement related to the MDA program should also provide the supportive environment needed in the community to support NTD volunteers. Programs need to consider these issues to improve working conditions for NTD volunteers.</p></div

PRISMA flow diagram.

<p>PRISMA flow diagram.</p

Percentage of publications by study design.

<p>Percentage of publications by study design.</p

Algorithms for diagnosing tuberculosis with and without a nucleic acid amplification test and associated resources consumed.

<p>Definition of abbreviations: AFB = Acid-fast bacillus; AII = airborne infection isolation; NAAT = nucleic acid amplification test; TB = tuberculosis. Legend: The squares represent decision nodes, circles a chance node, and triangles a terminal node. Each condition represents the sequence of events that may occur to patients with an AFB smear-positive respiratory specimen. Using cost inputs described in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0100649#pone-0100649-t001" target="_blank">Table 1</a>, we compared average cost per patient under each condition: “NAAT conditions” versus “no NAAT conditions”.</p

Model parameters, base case and reasonable ranges.

<p>AFB = Acid fast bacillus; AII = airborne infection isolation; GMH = Grady Memorial Hospital, Atlanta, GA, USA; NAAT = nucleic acid amplification test; PPV = positive predictive value; TB = tuberculosis</p><p>*Base case was determined by multiplying charge by cost/charge ratio.</p><p>∧This upper bound was determined in the cited publication by considering all aspects of outpatient care in calculating treatment cost and was included for sensitivity analyses.</p>†<p>We could not find estimates of exposure investigation cost in the literature, so for sensitivity analyses we took the extreme position of varying the cost from one tenth to 100 times the base case cost (for low and high bounds, respectively).</p>‡<p>TB prevalence among patients in our study population, i.e. those with an AFB smear-positive sputum sample. This is equivalent to the PPV of AFB smear microscopy.</p><p>#The TB prevalence among AFB smear positives in our study (i.e. PPV of AFB smear) was lower than any found in the literature. For lower bound of TB prevalence we used PPV among HIV patients in our study, i.e. as if all AFB smear-positive patients had HIV.</p

Positive predictive value of an AFB smear-positive respiratory specimen for culture-confirmed tuberculosis stratified by HIV status.

<p>AFB = Acid-fast bacillus; HIV+ = HIV-seropositive; HIV - =  HIV-seronegative; NTM = non-tuberculous mycobacteria; PPV = positive predictive value; TB = tuberculosis</p

Performance of a nucleic acid amplification test (NAAT) on AFB smear-positive respiratory specimens stratified by HIV status.

<p>AFB = Acid-fast bacillus; HIV+ = HIV seropositive; HIV- = HIV seronegative; NAAT = nucleic acid amplification test; NPV = negative predictive value; PPV = positive predictive value; TB = tuberculosis; + = positive; − = negative.</p

Map of the survey area.

<p>Map highlights Ebonyi State in southeast Nigeria, and the Local Government Areas of Ohaukwu and Abakaliki, where the November 2011 survey was conducted.</p

Demographic data of respondents who completed the extended KAP survey module.

<p>Demographic data of respondents who completed the extended KAP survey module.</p