title: Barriers to dog rabies vaccination during an urban rabies outbreak: Qualitative findings from Arequipa, Peru.
abstract: Canine rabies was reintroduced to the city of Arequipa, Peru in March 2015. The Ministry of Health has conducted a series of mass dog vaccination campaigns to contain the outbreak, but canine rabies virus transmission continues in Arequipa's complex urban environment, putting the city's 1 million inhabitants at risk of infection. The proximate driver of canine rabies in Arequipa is low dog vaccination coverage. Our objectives were to qualitatively assess barriers to and facilitators of rabies vaccination during mass campaigns, and to explore strategies to increase participation in future efforts.
  
  
  
  We conducted 8 focus groups (FG) in urban and peri-urban communities of Mariano Melgar district; each FG included both sexes, and campaign participants and non-participants. All FG were transcribed and then coded independently by two coders. Results were summarized using the Social Ecological Model. At the individual level, participants described not knowing enough about rabies and vaccination campaigns, mistrusting the campaign, and being unable to handle their dogs, particularly in peri-urban vs. urban areas. At the interpersonal level, we detected some social pressure to vaccinate dogs, as well as some disparaging of those who invest time and money in pet dogs. At the organizational level, participants found the campaign information to be insufficient and ill-timed, and campaign locations and personnel inadequate. At the community level, the influence of landscape and topography on accessibility to vaccination points was reported differently between participants from the urban and peri-urban areas. Poor security and impermanent housing materials in the peri-urban areas also drives higher prevalence of guard dog ownership for home protection; these dogs usually roam freely on the streets and are more difficult to handle and bring to the vaccination points.
  
  
  
  A well-designed communication campaign could improve knowledge about canine rabies. Timely messages on where and when vaccination is occurring could increase dog owners' perception of their own ability to bring their dogs to the vaccination points and be part of the campaign. Small changes in the implementation of the campaign at the vaccination points could increase the public's trust and motivation. Location of vaccination points should take into account landscape and community concerns.
authors.affiliation: Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America.|Zoonotic Disease Research Lab, Universidad Peruana Cayetano Heredia, Lima, Perú.
authors.forename: Ricardo
authors.identifier: 0000-0001-6629-2139
authors.initials: R
authors.lastname: Castillo-Neyra
authors.affiliation: Zoonotic Disease Research Lab, Universidad Peruana Cayetano Heredia, Lima, Perú.
authors.forename: Joanna
authors.initials: J
authors.lastname: Brown
authors.affiliation: Zoonotic Disease Research Lab, Universidad Peruana Cayetano Heredia, Lima, Perú.
authors.forename: Katty
authors.initials: K
authors.lastname: Borrini
authors.affiliation: Zoonotic Disease Research Lab, Universidad Peruana Cayetano Heredia, Lima, Perú.
authors.forename: Claudia
authors.initials: C
authors.lastname: Arevalo
authors.affiliation: Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America.|Zoonotic Disease Research Lab, Universidad Peruana Cayetano Heredia, Lima, Perú.
authors.forename: Michael Z
authors.initials: MZ
authors.lastname: Levy
authors.affiliation: Zoonotic Disease Research Lab, Universidad Peruana Cayetano Heredia, Lima, Perú.|Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States.
authors.forename: Alison
authors.initials: A
authors.lastname: Buttenheim
authors.affiliation: Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States.
authors.forename: Gabrielle C
authors.initials: GC
authors.lastname: Hunter
authors.affiliation: Microred Mariano Melgar, Ministerio de Salud, Arequipa, Perú.
authors.forename: Victor
authors.initials: V
authors.lastname: Becerra
authors.affiliation: Department of Economics, University of Pennsylvania School of Arts and Sciences, Philadelphia, Pennsylvania, United States of America.|Department of Sociology, University of Pennsylvania School of Arts and Sciences, Philadelphia, Pennsylvania, United States of America.
authors.forename: Jere
authors.initials: J
authors.lastname: Behrman
authors.affiliation: Zoonotic Disease Research Lab, Universidad Peruana Cayetano Heredia, Lima, Perú.|Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States.|Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Perú.
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Paz-Soldan
mesh_terms: D000818:Animals; D004196:Disease Outbreaks; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D004283:Dog Diseases / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D004285:Dogs; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D008297:Male; D010067:Ownership; D010568:Peru / Q000453:epidemiology; D011818:Rabies / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission / Q000662:veterinary*; D011819:Rabies Vaccines / Q000008:administration & dosage*; D013383:Suburban Population; D014505:Urban Population; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D011819:Rabies Vaccines