Kebele Elimination of Trachoma for Ocular Health

7项目概要/摘要 世界卫生组织（WHO）沙眼项目旨在消除沙眼作为一项公共卫生 到2020年，严格来说，这将是一个控制计划，因为感染并没有被消除。的 世卫组织建议每年向已测定流行率的地区大规模分发3至5次阿奇霉素 滤泡性沙眼（TF）高于10%，然后重新评估。然而，尽管长达十年的 每年大规模的阿奇霉素分布，埃塞俄比亚阿姆哈拉某些地区的TF患病率仍超过25%。 消除感染，定义为在特定的定义中将感染的发生率降低到零 地理区域，是可行的，实际上可能比对照更可持续，因为它可能不太可能 在一个实现了零新感染的社区，感染率将再次上升。在这里，我们建议测试两个 以核心群体为重点的替代性扫盲战略，以实现在kebele消灭 （行政单位由~15个村或开发队组成）一级。我们提出一个三臂簇 随机试验，以测试是否季度治疗（1）所有儿童年龄0-9岁的kebele加每年的质量 阿奇霉素分布或（2）所有0-9岁儿童在kebele与眼C。PCR检测沙眼感染 加上每年大规模的阿奇霉素分布，导致眼衣原体的患病率降低， Kebele与（3）WHO推荐的每年大规模阿奇霉素单独分配相比。的结果 这项试验预计将导致证据的替代药物为基础的战略，可能更可靠地导致 在比一个村庄更大的地理区域内完成消除。

7PROJECT SUMMARY/ABSTRACT The World Health Organization (WHO) Trachoma Program aims to eliminate trachoma as a public health concern by 2020—strictly speaking, this would be a control program, as infection is not being eliminated. The WHO recommends three to five annual mass azithromycin distributions to districts with measured prevalence of follicular trachoma (TF) above 10%, before re-assessment. However, despite as much as a decade of annual mass azithromycin distribution, TF prevalence in some districts of Amhara, Ethiopia remains over 25%. Elimination of infection, defined as reduction to zero in the incidence of infection in a specific defined geographic area, is feasible and may actually be more sustainable than control, as it may be less likely for infection to return in a community that has achieved zero new infections. Here, we propose to test two alternative antibiotic-based strategies for intensive targeting of core groups to achieve elimination at the kebele (administrative unit consisting of ~15 villages, or development teams) level. We propose a three-arm cluster randomized trial to test whether quarterly treatment of (1) all children aged 0-9 in the kebele plus annual mass azithromycin distribution or (2) all children aged 0-9 in the kebele with ocular C. trachomatis infection by PCR plus annual mass azithromycin distribution results in lower prevalence of ocular chlamydia and elimination in the kebele compared to (3) WHO-recommended annual mass azithromycin distribution alone. The results of this trial are expected to lead to evidence of alternative antibiotic-based strategies that may more reliably lead to complete elimination in geographic areas larger than a village.