Implementation Research Example on Trachoma

Esmael Habtamu Ali, Assistant Professor, LSHTM, UK; Bahirdar University, Ethiopia; Co-founder and Executive Director, Eyu -Ethiopia.

Trachoma. One of the most common neglected tropical diseases (NTDs).

By the end of this module, you will be able to:. .

Chapter 1: Promise and Problem. Chapter 2: Living up to the Promise.

Chapter 1: Promise and Problem. The application of “Promise and Problem” in IR Within the context of trachoma and its elimination strategies Learning Objectives: Understand the Trachoma magnitude and transmission - both global and Ethiopia context Identify the implementation problem in the SAFE strategy of Trachoma control in the Ethiopia context.

Normal upper tarsal conjunctiva. Close up of a person s tongue Description automatically generated with medium confidence.

Tarsal conjunctival scarring: “TS”. Close up of a person s mouth Description automatically generated with medium confidence.

Hyperendemic in many of the poorest and most remote rural areas in 42 countries.

Contact. Personal factors:. Poor hygiene. Infected Child.

Surgery to treat the blinding stage of the disease.

WHO Trachoma Elimination Targets. P revalence of trachomatous trichiasis (blinding stage of trachoma) “unknown to the health system” of <0.2% in adults aged ≥15 years.

Frequent facial cleanliness, improved living conditions, presence of latrines reduced transmission.

Despite the positive progresses, the SAFE strategy implementation is not yielding the anticipated results in some hyperendemic settings.

F&E component of the SAFE strategy are efficacious interventions for trachoma control.

Chapter 2: Living up to the Promise. The application of “Living up to the Promise” in implementation research Key components in designing and conducting implementation research explained Examples adapted from of a Phased out, ongoing and future IR studies from the Stronger SAFE Project A five-year Wellcome Trust funded project Multiple intervention and implementation effectiveness studies on A, F & E of the SAFE Project is currently undergoing in Ethiopia West Arsi Zone of Oromia Region.

Learning Objectives:. Understand the three key phases in implementation research.

Phase 1: Need assessment. Understanding (defining) the implementation problem.

Stronger SAFE:. Photo by Stronger SAFE project team.

Most common method used to understand implementation gaps.

Need Assessment 1: Hygiene Behavior. Observing human contact and hygiene behaviour and practices.

In-depth observations of households over 27-hour periods.

There was fidelity issue on the implementation of the F component of the SAFE strategy.

“E” Interventions if the SAFE focused around improving latrine access and utilisation.

Photos by Stronger SAFE team. Need Assessment 2: Fly Control.

Highly clustered transmission of trachoma at the household level.

Uninfected Child Uninfected household. Need Assessment 2: Fly Control.

Face Washing Intensity and Frequency Implementation Strategies.

Diagram Description automatically generated. Face Washing Implementation Strategies: Process.

Creating Enabling Environment. Diagram Description automatically generated.

Community Event with Households. soap, soap dish, WASH container with tap & WASH flier.

Multiple small-scale pilot studies conducted to test the Pull-Push strategy.

Based on these small-scale studies the following implementation strategies were developed.

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Effectiveness – Implementation Hybrid Trial Designs.

Effectiveness – Implementation Hybrid Type 3 Cluster Randomised Controlled Trial.

Trial Outline.

Acceptability. Interviews with implementers ( ease of delivery).

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