Facilitators and barriers in implementation of mass drug administration for lymphatic filariasis elimination in India: A protocol for systematic review and qualitative meta-synthesis

INTRODUCTION: Lymphatic filariasis (LF) is a debilitating and disabling parasitic disease of immense public health concern in India with more than 650 million people at risk. Mass drug administration (MDA) is the recommended preventive chemotherapy strategy to eliminate LF. But, its coverage and compliance has been a mixed success. There is an urgent need of evidence to strengthen the program further, which can be done by exploring and understanding implementer as well as beneficiary perspectives. OBJECTIVE: To systematically review the facilitators and barriers experienced during the coverage and compliance of MDA for LF elimination in India from both beneficiary and provider’s (health system) perspective. METHODS AND ANALYSIS: We will search at Medline database through PubMed and Embase, along with ProQuest and Google Scholar to retrieve literature. Original qualitative observational studies exploring challenges and enablers in MDA program will be screened by two independent reviewers systematically based on title and abstract followed by full text. The risk of bias will be assessed through critical appraisal skills program checklist for each included article. Data will be extracted in a pre-designed proforma with study characteristics, demographic features, and texts and quotes of qualitative data. Data will be analyzed through thematic analysis and motivation-opportunity-ability-behavior framework using MAXQDA software. ETHICS AND DISSEMINATION: This is a literature-based review with minimal privacy concerns. The findings of this study will be published in a peer-reviewed journal and disseminated through policy brief to program implementers.