The ADAPT Methodology

A boy is screened for trachoma in Ethiopia. People are checked for trachoma in a clinic in Ethiopia. Photo Credit: RTI International/ Timothy La Rose

The ADAPT methodology is a structured approach designed to help national programs overcome challenges in achieving disease elimination goals for neglected tropical diseases (NTDs). Developed by USAID’s Act to End Neglected Tropical Diseases | East program (Act | East), ADAPT guides programs in investigating survey failures and implementing corrective measures to enhance mass drug administration (MDA) and other interventions. This page summarize the ADAPT methodology. For more details, download the full technical brief, The ADAPT Methodology: How to Learn From Neglected Tropical Disease Failures.

To eliminate lymphatic filariasis (LF), trachoma, or onchocerciasis, the World Health Organization (WHO) recommends conducting multiple rounds of mass drug administration (MDA), followed by disease-specific surveys. If a national program fails to meet the criteria for stopping MDA, WHO recommends investigating why the prevalence remains above the elimination threshold and devising strategies to improve subsequent round(s) of MDA. After analyzing data from several countries where surveys failed to meet elimination thresholds, the World Health Organization (WHO) and its partners developed tools to help national NTD programs address these survey failures. USAID’s Act to End Neglected Tropical Diseases | East (Act | East) program drew on its experience supporting 13 countries to create the ADAPT methodology. ADAPT uses WHO and other tools to help programs investigate the reasons behind survey failure and develop effective responses:

Analyze:

  • Assess survey and MDA data to evaluate implementation quality, ensuring sampling and diagnostic methods were appropriate.
  • Review epidemiologic factors, including baseline prevalence, sanitation access, and vector characteristics.
  • Examine historical MDA data to identify coverage gaps or inconsistencies.

Determine:

  • Engage stakeholders, including ministry officials, community leaders, and drug distributors, to brainstorm potential reasons for survey failure.
  • Use participatory methods to triangulate data points and identify gaps in evidence.
  • Document suspected causes of ongoing transmission and prioritize them for further investigation.

Key resources and tools to Determine:

Add:

  • Collect new qualitative data through focus group discussions (FGDs), key informant interviews (KIIs), and other participatory approaches.
  • Address gaps in knowledge about community behaviors, social norms, and MDA implementation challenges.
  • Integrate qualitative findings with existing quantitative data to refine hypotheses about survey failures.

Key resources and tools to Add:

Prioritize:

  • Use findings to develop targeted action plans, focusing on strategies with the highest feasibility and potential impact.
  • Common interventions include microplanning, improved training for drug distributors, and enhanced social mobilization efforts.
  • Tailor solutions to address specific local barriers, such as cultural resistance or logistical challenges.

Key resources and tools to Prioritize:

Take Stock:

  • Conduct post-MDA evaluations, such as Coverage Evaluation Surveys (CES), to verify reported coverage and assess the effectiveness of adaptations.
  • Use After Action Reviews to identify successes and challenges, incorporating lessons into future MDAs.
  • Share findings with other regions or countries to promote learning and best practices globally.

Key resources and tools to Take Stock: