Ance with antihelmintic treatment highlight some of the pertinent issues that

Ance with antihelmintic treatment highlight some of the pertinent issues that need PP58 cancer addressing [8?0]. These reviews report similar findings across global and Indian-specific contexts. Notable issues that negatively impact compliance with treatment include fear of side effects, not feeling LF drugs are needed, lack of trust, distributor not coming and taking too many tablets. These reviews focus primarily on findings from the quantitative research portfolio while in this paper we describe the use of a novel survey methodology that combines the use of both qualitative and quantitative data. Indonesia was chosen as the location for this research. It is the only country in the world with three forms of LF present: Wuchereria bancrofti, Brugia timori and Brugia malayi. Indonesia has participated in the GPELF since 2002, using Albendazole and Diethylcarbamazine in yearly MDA to endemic districts. Across the archipelago, a variety of stages of the LF elimination programme exist hose completing mapping, some just beginning MDA, others moving onto post-TAS surveillance and increasingly, more IUs are applying for TAS. The process presented in this paper can be described as implementation research (IR). By its design implementation research follows a systematic process that begins with close collaboration between the research team, stakeholders and program implementers to identify a problem related to healthcare delivery and through research finds feasible solutions to improve delivery and access [11]. This paper describes the development of a tool using micronarratives to identify the bottlenecks related to LF drug delivery and drug uptake and the use of that survey to identify feasible recommendations for use in LF endemic communities in two endgame districts in Indonesia. The research also describes how the district health offices used these recommendations in the implementation of an additional MDA round and how that impacted reported drug coverage rates. Finally the implications of this research for LF elimination programmes with IUs in the endgame stages will be discussed.Materials and Methods Selection of the research sitesFollowing recommendations from the National LF Programme in Jakarta, two districts were selected as research sites: Depok City and Agam District. Both sites had completed multiple MDA rounds and were entering the endgame stage of their elimination programmes. Depok City is part of the greater metropolitan areas known as Jabodetabek (Jakarta, Bogor, Depok, Tangerang and Bekasi), which has a population greater than 28 million people, making it one of largest metropolis areas in the world. Depok City is located in West Java province, with a population of 1.75 million in 2010. LF species in this area is W. bancrofti and the mf rate was recorded as 1.83 (Ministry of Health Indonesia). In 2013, Depok City had completed five rounds of MDA to the whole IU, with coverage rates varying between 46 and 84 , per district calculations. In 2013, mf rates in the spot check and sentinel sites were 0 and the cityPLOS Neglected Tropical Diseases | DOI:10.1371/journal.pntd.0005027 November 3,3 /Improved MDA coverage in Endgame Districtshealth department applied to the National LF Programme to implement the TAS. They were denied due to persistent low coverage below 65 in all five PP58 site previous rounds, using standardized census estimates as the source of total population data, and they were instructed to conduct a further three MDA rounds. Agam.Ance with antihelmintic treatment highlight some of the pertinent issues that need addressing [8?0]. These reviews report similar findings across global and Indian-specific contexts. Notable issues that negatively impact compliance with treatment include fear of side effects, not feeling LF drugs are needed, lack of trust, distributor not coming and taking too many tablets. These reviews focus primarily on findings from the quantitative research portfolio while in this paper we describe the use of a novel survey methodology that combines the use of both qualitative and quantitative data. Indonesia was chosen as the location for this research. It is the only country in the world with three forms of LF present: Wuchereria bancrofti, Brugia timori and Brugia malayi. Indonesia has participated in the GPELF since 2002, using Albendazole and Diethylcarbamazine in yearly MDA to endemic districts. Across the archipelago, a variety of stages of the LF elimination programme exist hose completing mapping, some just beginning MDA, others moving onto post-TAS surveillance and increasingly, more IUs are applying for TAS. The process presented in this paper can be described as implementation research (IR). By its design implementation research follows a systematic process that begins with close collaboration between the research team, stakeholders and program implementers to identify a problem related to healthcare delivery and through research finds feasible solutions to improve delivery and access [11]. This paper describes the development of a tool using micronarratives to identify the bottlenecks related to LF drug delivery and drug uptake and the use of that survey to identify feasible recommendations for use in LF endemic communities in two endgame districts in Indonesia. The research also describes how the district health offices used these recommendations in the implementation of an additional MDA round and how that impacted reported drug coverage rates. Finally the implications of this research for LF elimination programmes with IUs in the endgame stages will be discussed.Materials and Methods Selection of the research sitesFollowing recommendations from the National LF Programme in Jakarta, two districts were selected as research sites: Depok City and Agam District. Both sites had completed multiple MDA rounds and were entering the endgame stage of their elimination programmes. Depok City is part of the greater metropolitan areas known as Jabodetabek (Jakarta, Bogor, Depok, Tangerang and Bekasi), which has a population greater than 28 million people, making it one of largest metropolis areas in the world. Depok City is located in West Java province, with a population of 1.75 million in 2010. LF species in this area is W. bancrofti and the mf rate was recorded as 1.83 (Ministry of Health Indonesia). In 2013, Depok City had completed five rounds of MDA to the whole IU, with coverage rates varying between 46 and 84 , per district calculations. In 2013, mf rates in the spot check and sentinel sites were 0 and the cityPLOS Neglected Tropical Diseases | DOI:10.1371/journal.pntd.0005027 November 3,3 /Improved MDA coverage in Endgame Districtshealth department applied to the National LF Programme to implement the TAS. They were denied due to persistent low coverage below 65 in all five previous rounds, using standardized census estimates as the source of total population data, and they were instructed to conduct a further three MDA rounds. Agam.