Angela Spencer, MBA, PhD(c)

Nominated From: Oregon Health Sciences University

Research Site: Universidad Peruana Cayetano Heredia

Research Area: Implementation Science

Primary Mentor: Seth O’Neal

Research Project


Implementing Ring Treatment to Control Neurocysticercosis in Northern Peru


Neurocysticercosis (NCC), a brain infection caused by pork tapeworm (Taenia solium), is the leading cause of acquired epilepsy in low- and middle-income countries. In Latin America, an estimated 400,000 – 1.5 million people are living with epilepsy due to NCC. The disease was declared eradicable in 1993, based on the existence of effective interventions to interrupt the pork tapeworm life cycle, but lack of resources and rural locations of endemic areas present challenges for control.

Ring Treatment is an effective, efficient, evidence-based intervention for controlling NCC transmission. Human tapeworm infection (taeniasis) causes NCC, thus taeniasis treatment is essential to control. Mass drug administration is effective in reducing T. solium transmission, but is inefficient due to low prevalence of taeniasis, resulting in >97% of drugs being applied to uninfected people. Ring Treatment is a control intervention where humans within 100-meter radius of a T. solium-infected pig receive taeniasis treatment. A recent randomized controlled trail in Peru found Ring Treatment to be equally effective to mass drug administration for reducing T. solium transmission. Ring Treatment requires an active community surveillance system to detect infected pork, and a coordinated health system response, neither of which are established in Northern Peru. Implementation research is needed to translate this evidence-based control intervention into sustainable public health practice. To gather information about factors for successful Ring Treatment implementation, in-depth interviews and focus groups will be conducted with health system staff at multiple levels (i.e. health districts, centers, and posts) in Northern Peru. Upon completion of this project, we will provide a validated tool for assessing organizational readiness and recommendations for Ring Treatment implementation strategies in Peru.


Research Significance

Implementation science is an emerging field that can contribute to the success of coordinated, community-based interventions. The goal of this research is to further develop implementation science frameworks for neglected zoonotic disease prevention and control, by examining the drivers of successful Ring Treatment implementation in Peru.

Effective interventions can reduce NCC incidence, but there has been a critical failure to translate research advances into programs. Adoption is limited by the lack of implementation research into the acceptability and feasibility of evidence-based approaches applied as public health programs. This research begins to codify necessary steps for health system uptake of Ring Treatment, an effective NCC control strategy, and will inform future implementation efforts by providing a validated tool for assessing organizational readiness to implement Ring Treatment.


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