Through the eyes of the participant: using photovoice to understand the experiences and effects of ivermectin MDA in the context of the BOHEMIA clinical trial in Kwale, Kenya.

Background: Assessing the acceptability of new malaria control interventions in clinical trials can be complex due to the need for strict ethical standards and specific trial procedures. While in-depth interviews and focus group discussions can provide useful insights, a more participatory method of data collection which complements these methods is photovoice. Photovoice offers a unique approach, empowering participants to share their experiences and perceptions on their own terms. Photovoice was employed alongside the BOHEMIA clinical trial (a trial investigating the safety and efficacy of ivermectin mass-drug administration (MDA) for malaria control) to explore participants' views on the trial and the effects of the intervention on individuals and communities.

Methods: Two participants from each of five villages involved in the trial (two intervention, three control) were purposively selected and trained on the ethical and technical use of cameras. During the final round of the intervention, participants photographed their trial experiences and the MDA effects. Two picture-sharing discussions were conducted to explore the picture content and reasons for their inclusion.

Results: Both intervention and control groups expressed confidence in the trial procedures, with pictures capturing barcode scanning and health assessments, activities reported to provide reassurance and enhance trust. Photos from both groups showed positive outcomes such as improved appetite and fewer mosquitoes. However, photos from the ivermectin group also showed clearing of jiggers and killing of bed bugs. Images of rashes, described as a negative effect of the MDA, were taken by both groups. Pictures of mosquito breeding sites and sources of intestinal worms were also shared by both groups.

Conclusion: Photovoice provided valuable insights into trial experiences, intervention effects, and revealed unexpected outcomes, such as killing of bedbugs, that warrant deeper exploration. It exposed broader community concerns of the source of malaria and intestinal worms not addressed by either the intervention or local health authorities.