Key strategies and interventions.

In Baringo County, Kenya, trachoma remains endemic despite repeated mass drug administration (MDA) efforts, with coverage in one of the wards consistently falling short of world health organization (WHO) targets. The disease is endemic in 12 out of the 47 counties in Kenya. Baringo county is a pastoral conflict, hard to reach area where eight rounds of mass drug administration (MDA) for trachoma have been implemented. In Loyamorok ward, treatment coverage has been below 68% against the WHO recommended threshold of 80%. Community engagements that promote participatory approaches are key to MDA success. In this study, we describe community-based participatory approaches qualitatively developed and implemented during the intervention phase of a study that involved a pre-intervention, intervention and post intervention phases and aimed to address barriers of community participation and access to trachoma MDA. Interviews and focus group discussions were used to identify barriers to community participation in MDA, that included power and gender dynamics, rampant insecurity, community myths and misconceptions, migration in search of water and pastures, vastness and terrain and ineffective teams which resulted to unsupervised swallowing of drugs during MDA campaigns. Stakeholders in trachoma were identified through meetings with national, county and sub-county health management teams. The stakeholders, community members and the research team used the identified barriers to formulate MDA strategies including effective stakeholder engagement, enhanced social mobilization, community awareness creation on trachoma, effective planning and execution of MDA and implementation monitoring of the MDA campaign, all aimed at increasing MDA coverage. Overall MDA coverage in the area increased from 67.6% in 2021 to 87% in 2023 thus meeting the WHO threshold of 80%. The use of community-based, participatory approaches in the development and implementation of data driven strategies has the potential to positively influence MDA coverage for trachoma, and other neglected tropical diseases.肯尼亚巴林戈郡（Baringo County）尽管多次开展大规模药物给药（mass drug administration, MDA）干预，沙眼仍呈地方性流行，其中一个行政选区的药物覆盖度始终未达到世界卫生组织（World Health Organization, WHO）的既定目标。肯尼亚47个郡中共有12个郡存在沙眼地方性流行；巴林戈郡属于牧区冲突频发、交通不便的偏远区域，已针对沙眼完成8轮大规模药物给药（MDA）干预。在洛亚莫罗克选区（Loyamorok ward），沙眼治疗覆盖度仅维持在68%以下，而WHO推荐的达标阈值为80%。促进参与式方法的社区参与是大规模药物给药（MDA）项目成功的核心关键。本研究定性描述了在一项涵盖干预前、干预中及干预后三个阶段的研究的干预阶段中，开发并实施的以社区为基础的参与式方法，该研究旨在破解社区参与障碍，提升沙眼大规模药物给药（MDA）的可及性。研究通过访谈与焦点小组讨论，识别出社区参与大规模药物给药（MDA）的多重障碍：包括权力与性别动态、频发的安全隐患、社区存在的认知误区与误解、为寻找水源与牧场而发生的人口流动、地域广袤且地形复杂，以及执行团队效能不足，上述问题直接导致大规模药物给药（MDA）活动中出现无人监督的服药行为。研究团队通过与国家、郡及分区卫生管理团队召开会议，确定了沙眼防控相关利益相关方；随后，利益相关方、社区成员与研究团队依托识别出的障碍，制定了一系列大规模药物给药（MDA）优化策略，包括强化利益相关方协同参与、提升社会动员力度、开展沙眼防控社区宣传教育、完善大规模药物给药（MDA）的规划与执行流程，以及对给药活动实施全流程监测，所有策略均以提升大规模药物给药（MDA）覆盖度为核心目标。最终，该区域的大规模药物给药（MDA）整体覆盖度从2021年的67.6%提升至2023年的87%，成功达到WHO设定的80%达标阈值。以社区为基础的参与式方法用于制定与实施数据驱动的防控策略，有望对沙眼及其他被忽视的热带病的大规模药物给药（MDA）覆盖度产生积极影响。