Targeted distribution of long-lasting insecticidal nets by community health workers to sustain household coverage: A pilot feasibility study in Western Uganda.

Universal coverage is defined by the World Health Organization as 1 long-lasting insecticidal net (LLIN) for 2 people in a household. While Uganda has been a leader in the distribution of LLINs, there are concerns regarding the longevity of LLINs. The main aim of this study was to address the LLIN coverage gap that emerges in the period after mass distribution campaigns through the implementation of a novel LLIN distribution strategy utilizing the existing community healthcare worker (CHW) infrastructure. We conducted a pilot feasibility study in two villages randomized to be the control or intervention. CHWs in both villages carried out their regular duties and calculated household eligibility to receive LLINs, classified as having a child under five positive for malaria and being below universal coverage. Only CHWs in the intervention village distributed LLINs to eligible households to reach universal coverage. Summary statistics were calculated for intervention implementation and malaria outcomes. Structured interviews were conducted with CHWs to assess burden and community acceptability of the intervention. Of the children evaluated by the CHWs, 102 of 169 (60.3%) and 112 of 171 (65.5%) were tested for malaria, of which 62 (60.7%) and 71 (63.3%) tested positive in the intervention and control villages, respectively. Only three households were at universal coverage. There was an increase from 4.0% to 6.5% of households meeting universal coverage in the intervention village, compared to a decrease from 7.8% to 1.8% in the control village after the follow-up period. There was an increase in the number of children under the age of 5 who slept under an LLIN the previous night from 15.7% to 31.6% in the intervention village compared to a decrease in the control village from 29.1% to 10.5%. No CHWs reported an increased burden from the intervention and all reported favorable opinions. Our pilot study demonstrates the feasibility and acceptability of targeted LLIN distributions leveraging the existing structure to supplement national distribution campaigns in Uganda. Overall, this work highlights the critical need for novel approaches to sustain LLIN coverage between distribution campaigns, particularly towards the end of the 3-year cycle.