Primary and Secondary Effects of Mass Antibiotic Distributions for Trachoma

描述(申请人提供)：我在寻求K23职业发展奖中有两个目标：1.通过对表面上已消除沙眼的人群进行深入分析，并通过评估大规模抗生素治疗对儿童发病率和死亡率的积极辅助影响，来提高我们对沙眼大规模抗生素分配的影响的理解；2.通过教学、指导和在发展中国家的实践研究经验，发展我作为一名独立研究人员的职业生涯。我将受益于两项临床试验的基础设施：TANA(北阿姆哈拉沙眼改善，U10 EY016214)和PRET(快速消除沙眼伙伴关系，盖茨基金会，#48027)。世界卫生组织发起 然而，旨在消除致盲沙眼的GET 2020(到2020年全球消除沙眼)计划尚未实现，特别是在高度流行的社区。大规模治疗已经在几次消除运动中使用，并被发现产生了意想不到的次要影响。我有以下具体目标：SA1：确定与基于DNA的检测相比，是否可以使用基于rRNA的核酸扩增来消除沙眼衣原体感染。 SA2a：确定阿奇霉素治疗是否能降低1-5岁儿童因腹泻、呼吸道疾病和疟疾而死亡。SA2B：确定阿奇霉素治疗是否能增加身高、体重和臂围。我的目标是确定在高度流行的社区是否可以完全消除沙眼，然后在总体上，特别是在世界卫生组织GET 2020计划内，迅速将这些研究成果转化为实践。生长指数是确定大规模治疗效果的常用方法；开发和测试用于测量生长和营养的仪器将为未来沙眼与其他被忽视的热带病(NTD)的整合研究提供重要的桥梁。 公共卫生相关性：该项目的目标是改善我们的 了解沙眼的大规模抗生素分布，评估 沙眼可能被消除的人群，并评估 这些大规模治疗的次要影响。这对于建立两者之间的关系至关重要 世卫组织全球消除沙眼运动的有效性和安全性。

DESCRIPTION (provided by applicant): I have two objectives in seeking a K23 career development award: 1. to improve our understanding of the effects of mass antibiotic distributions for trachoma by conducting an in depth analysis of populations in which trachoma has ostensibly been eliminated and by assessing the positive secondary effects of mass antibiotic treatments on childhood morbidity and mortality; 2. to develop my career as an independent investigator through didactics, mentorship and hands-on research experience in the developing world. I will benefit from the infrastructure of two clinical trials: TANA (Trachoma Amelioration in Northern Amhara, U10 EY016214) and PRET (Partnership for the Rapid Elimination of Trachoma, Gates Foundation, #48027). The WHO launched the GET 2020 (Global Elimination of Trachoma by the year 2020) program to eliminate blinding trachoma, however, the goals have not been met, particularly in hyperendemic communities. Mass treatments have been used in several elimination campaigns and have been found to have unintended secondary effects. I have the following specific aims: SA1: To determine if C. trachomatis infection can be eliminated using rRNA-based nucleic acid amplification compared to DNA-based testing. SA2a: To determine if azithromycin treatments reduce mortality in 1-5 year olds from diarrhea, respiratory disease and malaria. SA2b: To determine if azithromycin treatments effect increases in height, weight, and arm circumference. My goal is to determine if complete elimination is attainable in hyperendemic communities and then to translate these research findings quickly into practice within trachoma programs in general and within the WHO GET 2020 program in particular. Growth indices are a common method for determining the efficacy of mass treatment; developing and testing an instrument for measuring growth and nutrition will provide an important bridge to future studies on integration of trachoma with other neglected tropical diseases (NTD). PUBLIC HEALTH RELEVANCE: The goal of this project is to improve our understanding of mass antibiotic distributions for trachoma, assessing populations in which trachoma was presumably eliminated, and evaluating for secondary effects of these mass treatments. This is critical for establishing both the efficacy and safety of the WHO Global Elimination of Trachoma campaign.