03296nas a2200289   4500000000100000008004100001260003700042653002400079653005700103100001400160700001400174700001400188700001200202700001300214700001700227700001400244700001400258700001300272700001700285700001300302245017800315856009900493300000900592490000700601520238400608022001402992       2023                            d  bPublic Library of Science (PLoS)10aInfectious Diseases10aPublic Health, Environmental and Occupational Health1 aAruldas K1 aIsrael GJ1 aJohnson J1 aTitus A1 aSaxena M1 aKaliappan SP1 aRamesh RM1 aWalson JL1 aMeans AR1 aAjjampur SSR1 aPappas G00aImpact of adverse events during community-wide mass drug administration for soil-transmitted helminths on subsequent participation – a Theory of Planned Behaviour analysis  uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0011148&type=printable  a1-180 v173 a<p><strong>Background: </strong>Experiencing adverse events (AEs) during mass drug administration (MDA) could affect participation in future MDAs. This study aims to understand the potential influence of AEs during a community-wide MDA (cMDA) trial for soil-transmitted helminths (STH) in India on intention to participate in future cMDAs.</p>

<p><strong>Methods:</strong> This study was conducted using a multi-method quantitative and qualitative approach among 74 participants who experienced an AE during STH cMDA and the 12 participants who subsequently refused cMDA treatment of the ongoing DeWorm3 trial. Path analysis and thematic analysis guided by the Theory of Planned Behaviour, was used.</p>

<p><strong>Principal findings:</strong> Among 74 individuals who reported an AE, 12% refused treatment in the cMDA immediately subsequent to their AE and 4% refused in all subsequent cMDAs. Of these 74 individuals, 59 (80%) completed a survey and eight participated in in-depth interviews. A positive attitude towards deworming and perceived ability to participate in cMDA (perceived behavioural control) were significant predictors of intention to participate in cMDA (p&lt;0.05). A positive attitude towards cMDA was associated with caste (χ2 = 3.83, P = 0.05), particularly among the scheduled caste/scheduled tribe (SC/ST) (62%). Perceived behavioural control in cMDA participation was associated with occupation (χ2 = 5.02, P&lt;0.05), with higher perceived control among those engaged in skilled occupations (78%). Intention to participate in subsequent cMDAs was associated with caste and family type (χ2 = 3.83, P = 0.05 and χ2 = 7.50, P&lt;0.05 respectively) and was higher among SC/ST (62%) and those with extended families (67%). In-depth interviews demonstrated that perceived severe AEs may lead to treatment refusal in future, particularly if children were affected.</p>

<p><strong>Conclusions:</strong> Intention to participate in future STH cMDAs was associated with caste (SC/ST) and family type (extended families). Therefore, community mobilization messages about potential AEs and their management may need to intentionally target non-SC/ST households, nuclear families, and those engaged in unskilled occupations to increase cMDA participation given the possibility of AEs occurring. Trial registration NCT03014167, ClinicalTrials.gov.</p>
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