Optimal trachoma control after mass antibiotic distributions

描述(由申请人提供)：这个项目的目标是提供一种循证的方法来指导沙眼控制中重复的大规模抗生素治疗。沙眼仍然是传染性失明的主要原因。沙眼的病因，眼部衣原体感染，只需一剂阿奇霉素就能清除。然而，考虑到衣原体的社区池，治疗后再次感染是很常见的。因此，阿奇霉素的大规模治疗已被提倡，以减少眼部衣原体的社区池。目前正在埃塞俄比亚进行一项由NEI资助的试验，以使用大规模分发的抗生素来测试不同治疗策略对沙眼的疗效。尽管如此，关于沙眼的大规模抗生素分布仍有许多未知之处。利用在这次临床试验中收集的数据，我将解决以下具体目标：1)确定沙眼的临床症状与抗生素治疗后衣原体感染的实验室证据之间的关系。2)确定眼衣原体病治疗后患病率的社区预测因素。3)确定沙眼不同治疗方案的成本-效果。我的职业发展计划包括授课和指导。我计划在拨款的头两年在加州大学旧金山分校学习流行病学、生物统计学和卫生经济学方面的课程。在接下来的三年里，我将专注于数据分析，在加州大学旧金山分校有出色的导师：托马斯·利特曼博士、托德·马戈利斯博士、乔治·卢瑟福博士和迪恩·贾米森。我的短期目标是成为流行病学和卫生经济学的独立研究员，专注于发展中国家。我的长期目标是拥有一份成功而富有成效的职业生涯，成为一名学术眼科医生和流行病学家。相关性：通过世界卫生组织的倡导，沙眼研究可以相对较快地影响公共卫生项目。这项拟议的研究将帮助沙眼项目决定是否继续大规模抗生素治疗，决定哪些社区作为治疗目标，以及如何分配有限的资源。

DESCRIPTION (provided by applicant): The goal of this project is to provide an evidence-based approach to guide repeated mass antibiotic treatments in trachoma control. Trachoma remains the leading cause of infectious blindness. The cause of trachoma, ocular Chlamydia infection, is cleared with a single dose of azithromycin. However, given the community pool of Chlamydia, re-infection after treatment is common. Therefore, mass azithromycin treatment has been advocated to reduce the community pool of ocular Chlamydia. An NEI-funded trial is currently underway in Ethiopia to test the efficacy of different treatment strategies for trachoma, using mass antibiotic distributions. Nonetheless, much is still unknown about mass antibiotic distributions for trachoma. Using the data collected during this clinical trial, I will address the following specific aims: 1) To determine the relationship between clinical signs of trachoma and laboratory evidence of Chlamydia infection after antibiotic treatment. 2) To determine community predictors of post-treatment prevalence of ocular Chlamydia. 3) To determine the cost-effectiveness of different treatment strategies for trachoma. My career development plan includes didactics and mentorship. I plan on courses in epidemiology, biostatistics, and health economics at UCSF during the first 2 years of the grant. I will concentrate on data analysis during the remaining 3 years, with excellent mentors at UCSF: Drs. Thomas Lietman, Todd Margolis, George Rutherford, and Dean Jamison. My short term goal is to become an independent researcher in epidemiology and health economics, with a focus on developing countries. My long term goal is have a successful, productive career as an academic ophthalmologist and epidemiologist. RELEVANCE: Trachoma research can influence public health programs relatively quickly, through the advocacy of the World Health Organization. The proposed research will help trachoma programs to decide whether or not to continue mass antibiotic treatments, to decide which communities to target for treatment, and to decide how to allocate their limited resources.