{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"Research Square"}],"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T11:03:40Z","timestamp":1789556620364,"version":"build-2803163510"},"posted":{"date-parts":[[2026,9,16]]},"group-title":"In Review","reference-count":61,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,6,23]]},"abstract":"<title>Abstract<\/title>\n                <p>\n                  Background\n Cysticercosis (CC) is a zoonotic disease transmitted between pigs and humans, caused by the larval stage of T. solium that leads to neurological morbidity in humans and economic losses in pig-farming communities in low-resource rural regions. Ring Treatment (RT) is an evidence-based intervention that integrates a community participatory approach to provide antiparasitic treatment to households within 100-meters of an infected pig. This study aimed to evaluate the multiphase implementation of RT as a public health program in northern Peru, with a focus on feasibility, adoption, and sustainability.\nMethods\n We conducted a multi-method, three-phase implementation study from 2019\u20132025 in Tumbes, Peru. Phase 1 involved a formative evaluation using the expanded Consolidated Framework for Implementation Research for low- and middle-income countries. We used semi-structured interviews (n\u2009=\u2009169), social network surveys (n\u2009=\u2009341), and two process-mapping workshops (n\u2009=\u200926) to describe barriers, facilitators, and RT protocol adaptations.  In phase 2, we piloted RT in a small health district, reviewed registries, and conducted community surveys and interviews for quality improvement. In phase 3, we rolled out RT in two districts and applied the RE-AIM framework to assess implementation outcomes. Quantitative data were analyzed using descriptive statistics, while qualitative data underwent rapid qualitative analysis and template analysis (thematic analysis for hierarchical coding).\nResults\n Key facilitators included adaptability of existing health programs and strong engagement with community health workers (CHW) and communities. Barriers included high staff turnover, workload, and resource constraints. The pilot study achieved 75% treatment coverage among eligible populations, increased community knowledge of the CC transmission cycle, and prompted regional-level policy changes. During the RT rollout, 100% of health facilities established RT procedures, with moderate participation in training and treatment (53% and 87%). However, the COVID-19 pandemic and political instability limited the effectiveness of assessments and the completeness of data.\nConclusions\n RT is feasible and acceptable as a public health program for\n                  <italic>T. solium<\/italic>\n                  control in rural, endemic, low-resource settings. Success hinges on community and CHW involvement, adaptive protocols, and cross-sectoral partnerships. Continued investment in One Health approaches that view the human-animal-environment intersection as central to health is needed to sustain and expand progress in controlling zoonoses.\n                <\/p>","DOI":"10.21203\/rs.3.rs-10132093\/v1","type":"posted-content","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T10:20:11Z","timestamp":1789554011000},"source":"Crossref","is-referenced-by-count":0,"title":["A Multiphase Implementation of Ring Treatment: A Community-Engaged Control Program for T. Solium taeniasis\/cysticercosis in Northern Peru"],"prefix":"10.21203","author":[{"given":"Lisset Dumet","family":"Poma","sequence":"first","affiliation":[{"name":"Chestnut Health Systems"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Percy","family":"Vilchez","sequence":"additional","affiliation":[{"name":"Universidad Peruana Cayetano Heredia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Spencer","sequence":"additional","affiliation":[{"name":"University of Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Atto","sequence":"additional","affiliation":[{"name":"Universidad Peruana Cayetano Heredia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Cruz","sequence":"additional","affiliation":[{"name":"Universidad Peruana Cayetano Heredia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hector","family":"Garcia","sequence":"additional","affiliation":[{"name":"Universidad Peruana Cayetano Heredia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Bustos","sequence":"additional","affiliation":[{"name":"Universidad Peruana Cayetano Heredia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gracelyn","family":"Cruden","sequence":"additional","affiliation":[{"name":"Chestnut Health Systems"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth","family":"O'Neal","sequence":"additional","affiliation":[{"name":"Oregon Health & Science University \u2013 Portland State University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"e3257","DOI":"10.1371\/journal.pntd.0003257","article-title":"The Global One Health Paradigm: Challenges and Opportunities for Tackling Infectious Diseases at the Human, Animal, and Environment Interface in Low-Resource Settings","volume":"8","author":"Gebreyes WA","year":"2014","unstructured":"Gebreyes WA, Dupouy-Camet J, Newport MJ, et al. The Global One Health Paradigm: Challenges and Opportunities for Tackling Infectious Diseases at the Human, Animal, and Environment Interface in Low-Resource Settings. PLoS Negl Trop Dis. 2014;8:e3257.","journal-title":"PLoS Negl Trop Dis"},{"key":"ref2","unstructured":"WHO. (2022) One Health: Approach for action against neglected tropical diseases 2021\u20132030."},{"key":"ref3","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1097\/00001432-200310000-00007","article-title":"Diagnosis, treatment and control of Taenia solium cysticercosis","volume":"16","author":"Garcia HH","year":"2003","unstructured":"Garcia HH, Gonzalez AE, Gilman RH. Diagnosis, treatment and control of Taenia solium cysticercosis. Curr Opin Infect Dis. 2003;16:411\u20139.","journal-title":"Curr Opin Infect Dis"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"e0005130","DOI":"10.1371\/journal.pntd.0005130","article-title":"High Prevalence of Asymptomatic Neurocysticercosis in an Endemic Rural Community in Peru","volume":"10","author":"Moyano LM","year":"2016","unstructured":"Moyano LM, O\u2019Neal SE, Ayvar V, et al. High Prevalence of Asymptomatic Neurocysticercosis in an Endemic Rural Community in Peru. PLoS Negl Trop Dis. 2016;10:e0005130.","journal-title":"PLoS Negl Trop Dis"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1016\/S1474-4422(14)70114-0","article-title":"Epidemiology, causes, and treatment of epilepsy in sub-Saharan Africa","volume":"13","author":"Ba-Diop A","year":"2014","unstructured":"Ba-Diop A, Marin B, Druet-Cabanac M, Ngoungou EB, Newton CR, Preux P-M. Epidemiology, causes, and treatment of epilepsy in sub-Saharan Africa. Lancet Neurol. 2014;13:1029\u201344.","journal-title":"Lancet Neurol"},{"key":"ref6","first-page":"100140","article-title":"Burden of epilepsy in Latin America and The Caribbean: a trend analysis of the Global Burden of Disease Study 1990\u20132019","volume":"8","author":"Pacheco-Barrios K","year":"2022","unstructured":"Pacheco-Barrios K, Navarro-Flores A, Cardenas-Rojas A, de Melo PS, Uygur-Kucukseymen E, Alva-Diaz C, Fregni F, Burneo JG. Burden of epilepsy in Latin America and The Caribbean: a trend analysis of the Global Burden of Disease Study 1990\u20132019. Lancet Reg Health Am. 2022;8:100140.","journal-title":"Lancet Reg Health Am"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1016\/j.trstmh.2007.03.008","article-title":"Economic burden of neurocysticercosis: results from Peru","volume":"101","author":"Rajkotia Y","year":"2007","unstructured":"Rajkotia Y, Lescano AG, Gilman RH, Cornejo C, Garcia HH, Cysticercosis Working Group of Peru. Economic burden of neurocysticercosis: results from Peru. Trans R Soc Trop Med Hyg. 2007;101:840\u20136.","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1186\/s42269-021-00676-x","article-title":"Socio-economic and health costs of porcine\/human cysticercosis, neurocysticercosis and epilepsy to small-scale pig producers in Tanzania","volume":"45","author":"Kayuni EN","year":"2021","unstructured":"Kayuni EN. Socio-economic and health costs of porcine\/human cysticercosis, neurocysticercosis and epilepsy to small-scale pig producers in Tanzania. Bull Natl Res Cent. 2021;45:217.","journal-title":"Bull Natl Res Cent"},{"key":"ref9","unstructured":"Peruvian Ministry of Health. (2019) Programa presupuestal de enfermedades metaxenicas y zoonosis."},{"key":"ref10","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/S0035-9203(97)90042-0","article-title":"Mass chemotherapy for intestinal Taenia solium infection: effect on prevalence in humans and pigs","volume":"91","author":"Allan JC","year":"1997","unstructured":"Allan JC, Velasquez-Tohom M, Fletes C, Torres-Alvarez R, Lopez-Virula G, Yurrita P, Soto de Alfaro H, Rivera A, Garcia-Noval J. Mass chemotherapy for intestinal Taenia solium infection: effect on prevalence in humans and pigs. 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Mass treatment against human taeniasis for the control of cysticercosis: a population-based intervention study. Trans R Soc Trop Med Hyg. 2000;94:85\u20139.","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"2335","DOI":"10.1056\/NEJMoa1515520","article-title":"Elimination of Taenia solium Transmission in Northern Peru","volume":"374","author":"Garcia HH","year":"2016","unstructured":"Garcia HH, Gonzalez AE, Tsang VCW, et al. Elimination of Taenia solium Transmission in Northern Peru. N Engl J Med. 2016;374:2335\u201344.","journal-title":"N Engl J Med"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0003125","article-title":"Ring-Screening to Control Endemic Transmission of Taenia solium","author":"O\u2019Neal SE","year":"2014","unstructured":"O\u2019Neal SE, Moyano LM, Ayvar V, Rodriguez S, Gavidia C, Wilkins PP, Gilman RH, Garcia HH, Gonzalez AE. 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Int J Parasitol. 2010;40:515\u20139.","journal-title":"Int J Parasitol"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0118541","article-title":"A School Based Cluster Randomised Health Education Intervention Trial for Improving Knowledge and Attitudes Related to Taenia solium Cysticercosis and Taeniasis in Mbulu District, Northern Tanzania","author":"Mwidunda SA","year":"2015","unstructured":"Mwidunda SA, Carabin H, Matuja WBM, Winkler AS, Ngowi HA. A School Based Cluster Randomised Health Education Intervention Trial for Improving Knowledge and Attitudes Related to Taenia solium Cysticercosis and Taeniasis in Mbulu District, Northern Tanzania. PLoS ONE. 2015. https:\/\/doi.org\/10.1371\/journal.pone.0118541.","journal-title":"PLoS ONE"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"127","DOI":"10.4269\/ajtmh.1997.56.127","article-title":"Development and evaluation of a health education intervention against Taenia solium in a rural community in Mexico","volume":"56","author":"Sarti E","year":"1997","unstructured":"Sarti E, Flisser A, Schantz PM, et al. Development and evaluation of a health education intervention against Taenia solium in a rural community in Mexico. 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(2016) GPS Tracking of Free-Ranging Pigs to Evaluate Ring Strategies for the Control of Cysticercosis\/Taeniasis in Peru. PLoS Negl Trop Dis. https:\/\/doi.org\/10.1371\/journal.pntd.0004591"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1016\/j.lana.2024.100876","article-title":"Mass chemotherapy with niclosamide for the control of Taenia solium: population-based safety profile and treatment effectiveness","author":"Wardle MT","year":"2024","unstructured":"Wardle MT, Allen SE, Gamboa R, et al. Mass chemotherapy with niclosamide for the control of Taenia solium: population-based safety profile and treatment effectiveness. Lancet Reg Health \u2013 Americas. 2024. https:\/\/doi.org\/10.1016\/j.lana.2024.100876.","journal-title":"Lancet Reg Health \u2013 Americas"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"194","DOI":"10.4269\/ajtmh.1990.43.194","article-title":"Prevalence and Comparison of Serologic Assays, Necropsy, and Tongue Examination for the Diagnosis of Porcine Cysticercosis in Peru","volume":"43","author":"Gonzalez AE","year":"1990","unstructured":"Gonzalez AE, Cama V, Gilman RH, et al. Prevalence and Comparison of Serologic Assays, Necropsy, and Tongue Examination for the Diagnosis of Porcine Cysticercosis in Peru. 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Operational Guidelines for the Control Activities of Taeniasis and Cysticercosis Caused by *Taenia solium*; 2019."},{"key":"ref29","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1016\/j.pt.2019.04.012","article-title":"Can We Recommend Practical Interventions to Prevent Neurocysticercosis?","volume":"35","author":"Braae UC","year":"2019","unstructured":"Braae UC, Lightowlers MW, Donadeu M. Can We Recommend Practical Interventions to Prevent Neurocysticercosis? Trends Parasitol. 2019;35:592\u20135.","journal-title":"Trends Parasitol"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"2389","DOI":"10.3201\/eid2709.203349","article-title":"Geographically Targeted Interventions versus Mass Drug Administration to Control Taenia solium Cysticercosis, Peru","volume":"27","author":"O\u2019Neal SE","year":"2021","unstructured":"O\u2019Neal SE, Pray IW, Vilchez P, et al. 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