Ghana aims to eliminate onchocerciasis by 2030, but persistent transmission in areas like Kwanware-Ottou in Wenchi Health District (HD) poses challenges.

This research follows an earlier study in the Wenchi HD which showed that despite more than 27 years of community-directed treatment with ivermectin (CDTI) including three years of biannual treatment, there was still high microfilarial prevalence (36.6%), blackfly vector infectivity (6.7%) and seroprevalence (38%). The earlier study has delineated the focus of transmission within a 10km radius, encompassing the Kwanware-Ottou community, which has been identified as a high-transmission area. The main contributing factors were related to CDTI, including remote settlements, mobile populations and questionable treatment records.

In this study a mixed-method approach was used to identify strategies to improve CDTI. The approach involved community consultations, use of satellite imagery to identify settlements, qualitative assessments and an updated census which included questions on treatment history.

• To understand what strategies will deliver effective community-directed treatment with ivermectin (CDTI) in all population subgroups in Kwanware-Ottou and within the surrounding 10km radius
• To understand the location, population size, movement pattern and treatment histories (including those never treated) of minority and/or hard-to-reach population groups in Kwanware-Ottou and within the surrounding 10km radius

The results of this study will inform potential scale up/ adoption of such investigatory and participatory approaches in areas with unsatisfactory progress towards elimination.

• Mixed methods