Proyecto Tariki: Implementation Science for Community-Mobilized Risk Reduction of Dengue

ABSTRACT There is scientific consensus that there are effective tools and strategies to control dengue, but program failures are linked to improper implementation. This project brings together researchers with >23 years of experience in community-based epidemiological dengue research in Iquitos, implementation science, and a team that successfully developed and implemented a software platform DengueChat, in Nicaragua and Paraguay, that mobilized communities to control mosquito producing containers in their own homes. Our project directly addresses past implementation failures by using implementation science theories, models, and frameworks (INSPIRE, CFIR), dengue epidemiology and entomology expertise, infrastructure and relationships developed in Iquitos and Lima, and addresses three programmatic gaps identified in Iquitos and incorporates key lessons learned from the Covid pandemic (differential response to changing risk level), to develop, implement and evaluate "Proyecto Tariki" - an integrated dengue risk reduction program. Tariki will: (1) mobilize community members to take control measures in their own homes, (2) enhance surveillance of disease vectors and febrile case outbreaks, (3) improve triage and management of cases, (4) target and deploy effective responses during periods of high transmission, (5) promote bi-directional data exchange between community residents, health care providers and authorities, and other stakeholders, and (6) support government programs through community engagement and training and implementation on pragmatic evaluation protocols. We will conduct key-informant interviews and focus group discussions with health and community stakeholders to understand the system problems and establish a fixed-group of stakeholders called the 'Tariki Champions' (Aim 1). We will also adapt the proven DengueChat application to Iquitos and expand the platform to include fever surveillance; DengueChat Plus will be the cornerstone of the Tariki program. Tariki Champions will participate in group model building (GMB) workshops throughout the 5-year project to find leverage within the system to plan, implement, and monitor and evaluate Tariki using mixed methods based on RE-AIM metrics focused on epidemiological, entomological, and cost outcomes (Aims 1 and 2). In Year 3, after reviewing all data using the CFIR domains (including program characteristics, costs, and processes), the RMOH will take over management of Tariki and scale up program activities across the city of Iquitos (Aim 3), continuing to monitor the program through RE-AIM metrics and pragmatic evaluations. We hypothesize that Tariki will reduce risk for dengue by improving community mobilization for control, increasing community surveillance for febrile illness and case management, and implementing pragmatic protocols for intervention evaluation.