Speaker
Description
Background: Azithromycin Mass Drug Administration (MDA) has been highly effective in eliminating trachoma as a public health problem in many settings. However, trachoma persists in most parts of Ethiopia, regardless of more than 10 rounds of Azithromycin in some districts, which is at least two-fold higher than the WHO recommended rounds of MDA. We hypothesize, an intensive Azithromycin MDA strategy aimed at a core group of children could achieve faster trachoma elimination.
Objective: Determine whether an intensive, targeted azithromycin distribution strategy to core group of children is effective for elimination of trachoma at the kebele level compared to the WHO recommendation of annual azithromycin distribution.
Methods: A four-arm cluster-randomized control trial is being conducted in Merhabete District, North Shewa Zone, Amhara Region, Ethiopia since February 2022. Eighty Gotts were randomized (20 per arm) in 1:1:1:1 ratio to 1) the WHO-recommended annual azithromycin MDA to all residents (control arm), and three additional treatments to 2) all children aged 2-9 years, 3) children with chlamydia infection, and 4) children with clinical sign of trachomatous inflammation—intense. Clinical data on trachoma, conjunctival swabs to detect infection, and dried blood spots to determine transmission through serology were collected at baseline prior to randomization and intervention, and every 12-month for 3 years. The primary outcome is the community level ocular chlamydia prevalence at 36-month. Secondary outcomes include active trachoma prevalence, chlamydia bacterial load, seroconversion rate, and pneumococcal macrolide resistance.
Discussion: A baseline assessment, three annual community wide and nine targeted treatments, and a 12 and 36 -months follow-up assessment have been conducted. The trial is expected to provide evidence for alternative core-group based treatment strategies for trachoma control in hyperendemic areas where infection has persisted despite many years of treatment. The 12-month examination result showed promising finding.
