# Cross-sectional study to assess filarial infection among the never treated individuals in selected districts in India: a study protocol

## TL;DR

This study aims to assess filarial infection in individuals who have never taken mass drug administration in India to understand their role in disease transmission and reasons for non-compliance.

## Contribution

The study introduces a mixed-methods approach to identify and analyze never-treated individuals as potential infection reservoirs in LF-endemic regions.

## Key findings

- The study will determine the prevalence of filarial infection among never-treated individuals in four Indian districts.
- Qualitative data will reveal sociocultural and behavioral factors influencing non-compliance with mass drug administration.
- Logistic regression will identify factors associated with filarial infection in the study population.

## Abstract

With the global lymphatic filariasis (LF) elimination goal set to 2030, it is necessary to address challenges hindering the last-mile efforts. Never treated individuals are those who self-report that they have never taken the drugs for LF during any mass drug administration (MDA) rounds. Hence, it is necessary to identify these individuals and assess if they can be potential reservoirs of infection and understand the reasons for non-compliance.

This mixed method study, proposed for a period of 2 years, will assess the filarial infection status of never treated individuals from four LF-endemic districts in India. A multi-stage cluster sampling design will be followed to select the health subcentres from one highly endemic block in each of the selected districts. A random sample of 2535 never treated individuals from each block will be assessed for filarial infection by a cross-sectional blood survey. Qualitative surveys, including in-depth interviews and focus group discussions, will be conducted to elicit the reasons for their non-compliance. The prevalence of filarial infection will be summarised as frequencies and percentages. Univariate and multivariate logistic regression analysis will be performed to find the factors associated with filarial infection. Exploring the various reasons, such as sociocultural, behavioural and programmatic drivers of non-participation, will enable the programme to design tailored communication and community engagement strategies to bring them under the umbrella of MDA and thereby support the ongoing LF elimination efforts.

This study has been approved by the institutional ethics committee (IHEC 07-0824/N/F, dated 25 September 2024). After completion of the study, a workshop will be held with all stakeholders to disseminate the study findings.