Community Experiences and Perceptions of the Broad One Health Endectocide-Based Malaria Intervention in Africa Trial of Ivermectin Mass Drug Administration: A Longitudinal Qualitative Study in Kwale County, Kenya

Mass drug administration (MDA) of ivermectin is currently being evaluated for malaria control. Uptake and adherence to MDA are shaped by various individual, social, and operational factors; however, the authors of most studies have focused on individual drivers of uptake. In the present paper, a longitudinal qualitative study undertaken alongside the Broad One Health Endectocide-Based Malaria Intervention in Africa (BOHEMIA) ivermectin MDA clinical trial is reported to examine community experiences and perceptions of the trial and the ivermectin MDA. Using purposive maximum variation sampling, researchers selected five villages involved in the BOHEMIA trial (two in the intervention arm and three in the control arm). Before the trial, researchers lived in each village for 1 month, making observations and conducting in-depth interviews (IDIs) and focus group discussions (FGDs). They returned before the first MDA round and remained throughout all three rounds, gathering insights on trial implementation, community perceptions, and perceived effects of the MDA. During this period, a total of 22 IDIs were conducted, along with structured observation reports. Two months after the MDA, 15 FGDs were held in eight additional villages. The findings indicate that during the trial, addressing needs and confidence in the implementing institution fostered participation, whereas previous negative experiences with MDA interventions and perceived exclusion from community engagement activities reduced involvement. The MDA was widely perceived as effective in reducing mosquitoes and malaria in both arms of the trial. It was also seen as highly effective against bedbugs in the intervention arm. These insights highlight the importance of trust, engagement, and previous experiences in shaping community participation in MDA programs.