Kebele Elimination of Trachoma for Ocular Health

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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.