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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Barriers and Facilitators to Implementing Post-Validation Surveillance of Lymphatic Filariasis in Pacific Island Countries and Territories: A Conceptual Framework Developed from Qualitative Data

by
Harriet L. S. Lawford
1,*,
Holly Jian
1,
‘Ofa Tukia
2,
Joseph Takai
2,
Clément Couteaux
3,
ChoCho Thein
4,
Ken Jetton
4,
Teanibuaka Tabunga
5,
Temea Bauro
5,
Roger Nehemia
6,
Charlie Ave
6,
Grizelda Mokoia
7,
Peter Fetaui
7,
Fasihah Taleo
8,
Cheryl-Ann Udui
9,
Colleen L. Lau
1 and
Adam T. Craig
1
1
UQ Centre for Clinical Research, Faculty of Health, Medicine, and Behavioural Sciences, The University of Queensland, Brisbane, QLD 4006, Australia
2
Public Health Division, Ministry of Health, Nuku’alofa P.O. Box 59, Tonga
3
Wallis and Futuna Health Agency, Mata’utu 98600, Uvea, Wallis and Futuna
4
Ministry of Health and Human Services, Majuro 96960, Marshall Islands
5
Ministry of Health and Medical Services, Bairiki, Tarawa P.O. Box 67, Kiribati
6
Te Marae Ora—Ministry of Health, Avarua P.O. Box 109, Cook Islands
7
Niue Public Health Division, Halamahaga Rd, Alofi P.O. Box 40, Niue
8
Ministry of Health, Port Vila P.O. Box 177, Vanuatu
9
Bureau of Public Health, Palau Ministry of Health, Koror 96940, Palau
*
Author to whom correspondence should be addressed.
Trop. Med. Infect. Dis. 2026, 11(1), 27; https://doi.org/10.3390/tropicalmed11010027 (registering DOI)
Submission received: 12 December 2025 / Revised: 1 January 2026 / Accepted: 16 January 2026 / Published: 18 January 2026
(This article belongs to the Section Neglected and Emerging Tropical Diseases)
Versions Notes

Abstract

Eight Pacific Island Countries and Territories (PICTs) have been validated by the World Health Organization (WHO) as having eliminated lymphatic filariasis (LF) as a public health problem. WHO recommends that these countries implement post-validation surveillance (PVS) to ensure resurgence has not occurred. Some PICTs proactively conducted LF PVS even in the absence of specific recommendations or best-practice guidelines at the time of implementation. We aimed to explore the barriers and facilitators to implementing LF PVS in PICTs, with a view to informing context-specific strategies and regional guidelines. Key informant interviews were held between March and September 2024 with 15 participants involved in LF and/or neglected tropical disease surveillance. Transcripts were analysed thematically using a generalised deductive approach. A conceptual framework was developed to summarise themes with two main streams of barriers identified. Stream One Barriers included limited awareness of, and guidelines for, PVS requirements and competing national health priorities. Stream Two Barriers included cost, resource, and logistical barriers to conducting PVS. Participants called for clearer, contextually tailored guidelines, improved communication from WHO, and integration within existing systems. This study highlights the urgent need for operational guidance, policy advocacy, and capacity strengthening to ensure sustainable LF PVS in PICTs. Incorporating local context and leveraging existing health structures will be essential to prevent disease resurgence and maintain gains achieved through elimination programmes.
Keywords: lymphatic filariasis; post-validation surveillance; Pacific Island Countries and Territories; neglected tropical diseases; barriers and facilitators; thematic analysis; operational guidance; health systems integration; capacity strengthening; disease elimination lymphatic filariasis; post-validation surveillance; Pacific Island Countries and Territories; neglected tropical diseases; barriers and facilitators; thematic analysis; operational guidance; health systems integration; capacity strengthening; disease elimination

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MDPI and ACS Style

Lawford, H.L.S.; Jian, H.; Tukia, ‘O.; Takai, J.; Couteaux, C.; Thein, C.; Jetton, K.; Tabunga, T.; Bauro, T.; Nehemia, R.; et al. Barriers and Facilitators to Implementing Post-Validation Surveillance of Lymphatic Filariasis in Pacific Island Countries and Territories: A Conceptual Framework Developed from Qualitative Data. Trop. Med. Infect. Dis. 2026, 11, 27. https://doi.org/10.3390/tropicalmed11010027

AMA Style

Lawford HLS, Jian H, Tukia ‘O, Takai J, Couteaux C, Thein C, Jetton K, Tabunga T, Bauro T, Nehemia R, et al. Barriers and Facilitators to Implementing Post-Validation Surveillance of Lymphatic Filariasis in Pacific Island Countries and Territories: A Conceptual Framework Developed from Qualitative Data. Tropical Medicine and Infectious Disease. 2026; 11(1):27. https://doi.org/10.3390/tropicalmed11010027

Chicago/Turabian Style

Lawford, Harriet L. S., Holly Jian, ‘Ofa Tukia, Joseph Takai, Clément Couteaux, ChoCho Thein, Ken Jetton, Teanibuaka Tabunga, Temea Bauro, Roger Nehemia, and et al. 2026. "Barriers and Facilitators to Implementing Post-Validation Surveillance of Lymphatic Filariasis in Pacific Island Countries and Territories: A Conceptual Framework Developed from Qualitative Data" Tropical Medicine and Infectious Disease 11, no. 1: 27. https://doi.org/10.3390/tropicalmed11010027

APA Style

Lawford, H. L. S., Jian, H., Tukia, ‘O., Takai, J., Couteaux, C., Thein, C., Jetton, K., Tabunga, T., Bauro, T., Nehemia, R., Ave, C., Mokoia, G., Fetaui, P., Taleo, F., Udui, C.-A., Lau, C. L., & Craig, A. T. (2026). Barriers and Facilitators to Implementing Post-Validation Surveillance of Lymphatic Filariasis in Pacific Island Countries and Territories: A Conceptual Framework Developed from Qualitative Data. Tropical Medicine and Infectious Disease, 11(1), 27. https://doi.org/10.3390/tropicalmed11010027

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