Developing an eco-bio-social conceptual framework for dengue virus transmission in Latin America and the Caribbean: An e-Delphi study

Dengue is a rapidly proliferating, mosquito-borne arboviral disease caused by the dengue virus (DENV), and is endemic in Latin America and the Caribbean (LAC). Evidence from the literature suggests that there are several ecological, biological, and social (eco-bio-social) factors determining dengue endemicity in the region. The primary objective of this study was to develop an eco-bio-social conceptual framework for dengue transmission in LAC. The secondary objective was to establish research, and policy and program agendas for dengue prevention and control in LAC. We conducted a sequential, multi-method study using a 3-round e-Delphi method between May and November 2023. Questionnaires were written in English and translated into Spanish and Portuguese, and data were analyzed quasi-anonymously. Professional panelists evaluated the framework using a 10-item, 7-point Likert scale. Consensus was defined as 70% or more agreement among panelists. Panelists also developed a research agenda and evaluated a policy and program agenda using a 12-item, 7-point Likert scale. Eleven dengue professionals from seven LAC countries participated in this study. The most relevant eco-bio-social factors determining dengue transmission were seasonal weather and urban microclimatic oscillations, vectorial capacity and competence, and urbanization and land use. After three consultation rounds, consensus was achieved on a framework comprising 16 ecological, 11 biological, and 28 social factors. Panelists developed a research agenda based on 3 research themes: ecological and environmental; biological and immunological; and social and cultural research. Panelists developed a policy and program agenda for dengue prevention and control, including 4 categories: government investments, integrated programs, intersectoral approaches, and innovative practices. Majority of panelists (88%) agreed that the agenda can improve dengue prevention and control in LAC. The consensus-based eco-bio-social framework and agendas offer novel opportunities to transform dengue prevention and control strategies in LAC and to address the specific needs and experiences of community members in LAC.