Implementation Challenges of Community Directed Treatment with Ivermectin Program for Control of Onchocerciasis in Ulanga, Tanzania

Background: Community drug distributors (CDDs) have a crucial role in distributing ivermectin for onchocerciasis control and prevention. Their roles, experiences and challenges faced in the implementation of community-directed treatment with ivermectin (CDTI) programme could potentially affect coverage, consequently leading to persistent transmission. Therefore, this study aimed to explore the experience and the roles which CDDs plays in implementation of community directed treatment with ivermectin program for onchocerciasis control in Ulanga, Tanzania. Methods: A cross-sectional study design was used to collect qualitative data in 2018 in Ulanga district, Tanzania. Five community drug distributors were purposively selected for in-depth interviews. Thematic framework approach for qualitative data analysis was used to generate codes, categories and themes. Results: Out of the five community drug distributors interviewed, two had experience of 15 to 20 years on implementation of the community directed treatment with ivermectin programme while the remaining community drug distributors had experience of less than 10 years. The main challenges faced by CDDs in the implementation of the CDTI programme include; the geographical location of the hamlets (hard to reach hamlets), long distances between houses, low compliance of community members to medication due to fear of side effects experienced before and mistrust of methods of dose calculation, short time of drug distribution and absence of people from their households as the exercise was conducted when community members were involved in agricultural activities. Conclusions: The challenges faced in the implementation of the CDTI programme could negatively affect the distribution and coverage of ivermectin treatment in the Ulanga district. It’s now an opportune time to address the challenges that CDDs are facing in the implementation of the CDTI programme to ensure effective control of onchocerciasis in the district.