Development of an Active Surveillance and Screening System for High-Risk Groups of Liver Fluke Infection Using Rapid Diagnostic Test (OV-ATK) through the Participation of Primary Health Care Networks at Ban Song Hong Health Promoting Hospital

Abstract

Purposes: To study the situation and context, develop a system, evaluate, and draw lessons learned regarding the active surveillance and screening system for liver fluke risk groups using rapid diagnostic tests (OV-ATK) through the participation of the primary health care network at Ban Song Hong Health Promoting Hospital.

Study design: This study employed an Action Research design based on Kemmis and McTaggart's framework, consisting of four stages: Planning, Action, Observation, and Reflection.

Materials and Methods: The key informants comprised 3 groups totaling 23 individuals, including civil society, academic sectors, and political sectors, selected via purposive sampling, alongside a sample of 131 Village Health Volunteers (VHVs). The research instruments included rapid urine test kits (OV-ATK), ultrasonography equipment, interview forms, observation records, and a 6-part questionnaire, all of which were verified for content validity by experts and tested for reliability. Data were collected from February to August 2025. Statistics used for data analysis included percentages, means, standard deviations, and Paired Samples t-tests.

Main findings: (1) Situation, context, and research gaps: Khok Sung sub-district was identified as a high-risk area with a population practicing raw fish consumption and facing continuous mortality from cholangiocarcinoma (an increase of 5 fatalities in 2025). Three major research gaps were identified: a lack of a primary healthcare service model compatible with OV-ATK innovation, a lack of an integrated and concrete community network role, and a lack of a framework linking liver fluke screening with Non-Communicable Diseases (NCDs) care. (2) Active surveillance and screening system: A service model named "Model Families Free of Liver Fluke and Reduced Risk of Cholangiocarcinoma" was developed through 5 key measures: establishing a Memorandum of Understanding (MOU), capacity building for leaders and active screening using OV-ATK and ultrasound, community mobilization via public broadcasting towers and house-to-house visits, rapid monitoring and referral for treatment, and lessons learned to integrate into local development plans. (3) Evaluation results: Post-development, VHVs demonstrated significantly increased mean scores in knowledge, roles, participation, and active surveillance/screening behaviors (p < 0.001). Regarding the proactive screening results, a total of 775 individuals at risk underwent screening, with 498 testing positive, accounting for 64.62%. Overall satisfaction with the implementation was at the highest level.

Conclusion and recommendations: Relevant agencies should continuously expand the "Model Families" service model by utilizing the local health insurance fund (LHIF) mechanism to support budgetary funding for re-screening using OV-ATK and ultrasound. Additionally, they should develop a digital health database system to link liver fluke infection data with the care of non-communicable diseases (NCDs), as well as promote the role of Village Health Volunteers (VHVs) to act as home-visiting family doctors, provide nutritional advice, and regularly campaign for the modification of raw food consumption behaviors.