title: A qualitative study of perceptions of a mass test and treat campaign in Southern Zambia and potential barriers to effectiveness.
abstract: BACKGROUND
  A mass test and treat campaign (MTAT) using rapid diagnostic tests (RDTs) and artemether-lumefantrine (AL) was conducted in Southern Zambia in 2012 and 2013 to reduce the parasite reservoir and progress towards malaria elimination. Through this intervention, community health workers (CHWs) tested all household members with rapid diagnostic tests (RDTs) and provided treatment to those that tested positive.
  
  
  METHODS
  A qualitative study was undertaken to understand CHW and community perceptions regarding the MTAT campaign. A total of eight focus groups and 33 in-depth and key informant interviews were conducted with CHWs, community members and health centre staff that participated in the MTAT.
  
  
  RESULTS
  Interviews and focus groups with CHWs and community members revealed that increased knowledge of malaria prevention, the ability to reach people who live far from health centres, and the ability of the MTAT campaign to reduce the malaria burden were the greatest perceived benefits of the campaign. Conversely, the primary potential barriers to effectiveness included refusals to be tested, limited adherence to drug regimens, and inadequate commodity supply. Study respondents generally agreed that MTAT services were scalable outside of the study area but would require greater involvement from district and provincial medical staff.
  
  
  CONCLUSIONS
  These findings highlight the importance of increased community sensitization as part of mass treatment campaigns for improving campaign coverage and acceptance. Further, they suggest that communication channels between the Ministry of Health, National Malaria Control Centre and Medical Stores Limited may need to be improved so as to ensure there is consistent supply and management of commodities. Continued capacity building of CHWs and health facility supervisors is critical for a more effective programme and sustained progress towards malaria elimination.
authors.affiliation: PATH Malaria Control and Evaluation Partnership in Africa (MACEPA), Lusaka, Zambia. ksilumbe@path.org.
authors.forename: Kafula
authors.initials: K
authors.lastname: Silumbe
authors.affiliation: PATH Malaria Control and Evaluation Partnership in Africa (MACEPA), Lusaka, Zambia. echiyende@path.org.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Chiyende
authors.affiliation: Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. tfinn2@tulane.edu.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Finn
authors.affiliation: PATH Malaria Control and Evaluation Partnership in Africa (MACEPA), Lusaka, Zambia. mdesmond@path.org.
authors.forename: Michelle
authors.initials: M
authors.lastname: Desmond
authors.affiliation: PATH Malaria Control and Evaluation Partnership in Africa (MACEPA), Lusaka, Zambia. cputa@path.org.
authors.forename: Chilunga
authors.initials: C
authors.lastname: Puta
authors.affiliation: National Malaria Control Centre, Ministry of Health, Lusaka, Zambia. bossbusk@gmail.com.
authors.forename: Busiku
authors.initials: B
authors.lastname: Hamainza
authors.affiliation: National Malaria Control Centre, Ministry of Health, Lusaka, Zambia. mkamuliwo@yahoo.co.uk.
authors.forename: Mulakwa
authors.initials: M
authors.lastname: Kamuliwo
authors.affiliation: Department of Public Health, Food Studies and Nutrition, Syracuse University David B Falk College of Sport and Human Dynamics, Syracuse, NY, USA. dalarsen@syr.edu.
authors.forename: David A
authors.initials: DA
authors.lastname: Larsen
authors.affiliation: Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. teisele@tulane.edu.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Eisele
authors.affiliation: PATH Malaria Control and Evaluation Partnership in Africa (MACEPA), Lusaka, Zambia. jmiller@path.org.
authors.forename: John
authors.initials: J
authors.lastname: Miller
authors.affiliation: Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. bennetta@globalhealth.ucsf.edu.|Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, 550 16th St., San Francisco, CA, 94158, USA. bennetta@globalhealth.ucsf.edu.
authors.forename: Adam
authors.initials: A
authors.lastname: Bennett
mesh_terms: D001291:Attitude of Health Personnel; D003150:Community Health Workers / Q000523:psychology; D003955:Diagnostic Tests, Routine / Q000523:psychology*; D017144:Focus Groups; D006282:Health Personnel / Q000523:psychology; D008288:Malaria / Q000517:prevention & control / Q000523:psychology*; D010465:Perception; D011795:Surveys and Questionnaires; D015024:Zambia