Seeing the Big Picture: Organizational network mapping to support implementation of an evidence-based parasite control intervention in Northern Peru

Angela G. Spencer, Sarah Gimbel, Ruth Atto Espinoza, Percy Vilchez, Brenda Beltran, Javier Bustos, Hector H. Garcia, Patricia J. Garcia, Seth E. O'Neal, For The Cysticercosis Working Group In Peru


The pork tapeworm parasite (Taenia solium) is the causative agent of a human brain infection known as neurocysticercosis (NCC). NCC is a leading cause of acquired epilepsy worldwide. This zoonotic parasite also infects pigs, resulting in substantial economic harm due to contaminated pork in rural areas where transmission occurs. In Northern Peru, where the parasite is endemic, we are working to implement an evidence-based control strategy called ring treatment (RT). RT is a focal control strategy in which people who live in the vicinity of an infected pig are treated for tapeworm with an antiparasitic drug (niclosamide). Because people with tapeworms are the source of infection of pigs, a confirmed pig infection suggests that a tapeworm carrier is likely nearby. In a recent randomized controlled trial, RT was equally effective to mass drug administration (MDA) in controlling T. solium transmission, but distributed far fewer antiparasitic drugs than MDA, saving staff resources and reducing the number of uninfected people treated. Implementation research can provide critical information on effectively establishing government-administered RT as a practice across heterogeneous settings, and inform its scaling at regional and national levels. We are using the Consolidated Framework for Implementation Research (CFIR) to guide our implementation efforts and inform future scaling. CFIR identifies constructs associated with effective implementation, across five domains (intervention characteristics, outer setting, inner setting, characteristics of individual, implementation process). For this project we are targeting the networks and communication constructs, to identify how they drive acceptance of the RT intervention. Using CFIR-informed questionnaires, we are mapping professional networks within the public health system, as well as their linkages to animal health and community organizations. These findings will support protocol development for future RT scaling. Our network mapping methods include intra- and inter-organizational networks at baseline, changes over time, and identify key linkages needed to effectively implement RT. This work demonstrates application of CFIR to a One Health project, focusing on the intersection of human, animal, and environmental health in Peru.

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