Community Acceptance of Reactive Focal Mass Drug Administration and Reactive Focal Vector Control Using Indoor Residual Spraying, a Mixed-Methods Study in Zambezi Region, Namibia

Abstract Background In Namibia, as in many malaria elimination settings, reactive case detection (RACD), or malaria testing and treatment around index cases, is a standard intervention. Reactive focal mass drug administration (rfMDA), or treatment without testing, and reactive focal vector control (RAVC) in the form of indoor residual spraying, are alternative or adjunctive interventions, but there is limited data regarding their community acceptability. Methods A parent trial aimed to compare the effectiveness of rfMDA versus RACD, RAVC versus RAVC, and rfMDA+RAVC versus RACD only. To assess acceptability of these interventions, we conducted a mixed-methods study that included key informant interviews (KIIs) and focus group discussions (FGDs) in three rounds (pre-trial and in years 1 and 2 of the trial), and an endline survey. Results In total, 17 KIIs, 49 FGDs were conducted with 449 people over three annual rounds of qualitative data collection. Pre-trial, community members more accurately predicted the level of community acceptability than key stakeholders. Throughout the trial, key participant motivators included: malaria risk perception, access to free community-based healthcare and IRS, and community education by respectful study teams. RACD or rfMDA were offered to 1,372 and 8,948 individuals in Years 1 and 2, respectively and refusal rates were low (<2%). RAVC was offered to few households (n=72) in Year 1. In year 2, RAVC was offered to more households (n=944) and refusal were <1%. In the endline survey, 94.3% of 2,147 respondents said they would participate in the same intervention again. Conclusions Communities found both reactive focal interventions and their combination highly acceptable. Engaging communities and centering and incorporating their perspectives and experiences during design, implementation, and evaluation of this community-based intervention was critical for optimizing study engagement.