Taking innovative vector control interventions in urban Latin America to scale: lessons learnt from multi-country implementation research

Abstract

Prior to the current public health emergency following the emergence of chikungunya and Zika Virus Disease in the Americas during 2014 and 2015, multi-country research investigated between 2011 and 2013 the efficacy of novel Aedes aegypti intervention packages through cluster randomised controlled trials in four Latin-American cities: Fortaleza (Brazil); Girardot (Colombia), Acapulco (Mexico) and Salto (Uruguay). Results from the trials led to a scaling up effort of the interventions at city levels. Scaling up refers to deliberate efforts to increase the impact of successfully tested health interventions to benefit more people and foster policy and program development in a sustainable way. The different scenarios represent examples for  a ‘vertical approach’ and a ‘horizontal approach’. This paper presents the analysis of a preliminary process evaluation of the scaling up efforts in the mentioned cites, with a focus on challenges and enabling factors encountered by the research teams, analysing the main social, political, administrative, financial and acceptance factors.

Keywords:

• Aedes aegypti
• vector control
• prevention
• scaling up
• process evaluation
• Latin America

Abbreviations:

• TDR-IDRC: Special Programme of Training in Tropical Medicine-International Development Research Center
• MoH: Ministry of Health
• ITS: Insecticide Treated Screens
• VS: Vivienda Segura
• LLIN: long-lasting insecticidal-nets
• NGOs: Non Gubermental Organizations
• CONACYT: Concejo Nacional de Ciencia y Tecnología
• WHO: World Health Organization
• PAHO: Panamerican Health Organization

Acknowledgements

We thank the national and local governments in Brazil, Colombia, Mexico and Uruguay for the support of the interventions and scaling up initiative.

Additional information

Funding

This work was financially supported by the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) and International Development Research Center (IDRC) [grant number HQTDR1409927]; In Mexico, the studies additionally received financial support by el Consejo Nacional de Ciencia y Tecnologia (CONACYT) through the Projects ‘Control integrado de Ae. aegypti con estrategias y herramientas innovadoras en la zona de alto riesgo para la transmisión del dengue en Guerrero México’ y ‘Casas y escuelas a prueba de Aedes aegypti para maximizar el control y la prevención del dengue en áreas de riesgo en Yucatán’. In Colombia, the study received additional support of the International Development Research Center (IDRC) through the project ‘Intersectoral Municipal Leadership for Health’ and by the Departamento de Ciencia, Tecnología e Innovación Colciencias (CTeI) and through the project ‘Enfoque Ecobiosocial para el diseño e implementación de una estrategia sostenible para el control del vector de dengue en Girardot, Fase 3. Viabilidad y costo efectividad de una intervención innovadora para el control del vector de dengue’ [project number 622172553374].