Engaging community influencers to increase mass drug administration uptake for neglected tropical diseases in South Sudan

Abstract South Sudan is endemic for all preventive chemotherapy neglected tropical diseases, and counties including Awerial, Kapoeta North and Kajo-Keji face persistent transmission and high absenteeism and refusal rates for mass drug administration (MDA). To identify barriers, we conducted a mixed-methods root cause analysis (combining a quantitative KoboToolbox survey with focus group discussions and key informant interviews), using WI-HER’s identify, design, apply/assess, record, and expand (iDARE) methodology with gender equity and social inclusion (GESI) at its core. Fundamental to our approach, we trained community-selected influencers (local leaders and respected community figures) in GESI principles and behavior change techniques, supporting them to co-design and implement locally contextualized solutions. Following influencer-led engagement in Awerial County, cohort members demonstrated a 90.9% improvement in MDA uptake. This pilot project demonstrates that sustainable increases in MDA coverage require a community-grounded approach that integrates localized barrier analysis, GESI-informed influencer training and ongoing community engagement.