Sanitation, Water, and Instruction in Face-washing for Trachoma

沙眼的卫生、水和洗脸指导

• 批准号: 8742315
• 负责人: Jeremy David Keenan
• 金额: $ 66.39万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-30 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8742315
• 关键词: Adverse effects; Affect; Aftercare; Antibiotic Therapy; Antibiotics; Area; Azithromycin; Blindness; Chlamydia; Chlamydia Infections; Clinical; Clinical Trials; Communities; Consensus; Cost Effectiveness Analysis; Disadvantaged; Disease; Dose; Education; Effectiveness; Ethiopia; Face; Generations; Goals; Government; Hygiene; Infection; Instruction; Intervention; Latrine; Light; Location; Macrolide-resistance; Measures; Modeling; Monitor; Operative Surgical Procedures; Oral; Organism; Photography; Poverty Areas; Prevalence; Public Health; Randomized; Randomized Clinical Trials; Research; Resistance; Resources; Risk Factors; Role; Sanitation; Services; Severities; Streptococcus pneumoniae; Testing; Time; Trachoma; Visit; Water; Water Supply; Work; World Health Organization; cost effective; cost effectiveness; evidence base; pathogen; prevent; primary outcome; programs; respiratory; secondary outcome; standard of care; success; transmission process

DESCRIPTION (provided by applicant): The aim of the proposed project is to determine whether a comprehensive water and sanitation package is a cost-effective strategy to hasten trachoma elimination. Mass azithromycin distributions are effective in clearing the ocular strains bf chlamydia that cause trachoma, but do not eliminate trachoma in the most severely affected areas. Moreover, mass antibiotic treatments have the disadvantage of selecting for resistance among commensal organisms. Because poor hygiene is thought to be an important risk factor for trachoma, the World Health Organization recommends non-antibiotic hygiene improvements for trachoma (e.g., latrines, water supply, and promotion of face washing). However, no randomized clinical trial has ever demonstrated that any of these measures prevent transmission of ocular chlamydia, and no trials have even been conducted in which the entire package of WHO-recommended interventions are implemented together. The current submission attempts to fill that gap, by randomizing communities in Ethiopia to either a package of hygiene interventions, or to standard of care. In the trial, all communities will receive a singe dose of oral azithromycin. Communities randomized to the hygiene package will receive wells, latrines, and education on face washing. Communities randomized to standard of care will receive the current hygiene promotion services provided by the government. The co-primary outcomes of the trial will be improvement in clinical trachoma and the prevalence of ocular chlamydia at 36 months after the baseline visit. Secondary outcomes will include chlamydial load from quantitative PCR and nasopharyngeal pneumococcal macrolide resistance. A cost-effectiveness analysis will be performed to allow trachoma programs to better decide how to use their limited resources. RELEVANCE (See instructions): Trachoma remains the leading infectious cause of blindness worldwide. Trachoma is most common in areas of poverty, with poor hygiene thought to be a contributing factor. However, there have been no clinical trials demonstrating that improvements in public health and hygiene are effective for trachoma. This trial seeks to provide a stronger evidence base to guide decisions on non-antibiotic measures for trachoma control.

描述（由申请人提供）：拟议项目的目的是确定全面的水和卫生设施是否是加速消除沙眼的具有成本效益的策略。大规模阿奇霉素分发可有效清除引起沙眼的衣原体眼部劳损，但不能消除受影响最严重区域的沙眼。此外，大规模抗生素治疗的缺点是会在共生生物中选择耐药性。由于卫生条件差被认为是沙眼的一个重要危险因素，世界卫生组织建议针对沙眼进行非抗生素卫生改善（例如厕所、供水和提倡洗脸）。然而，还没有随机临床试验证明这些措施可以预防眼部衣原体传播，甚至还没有进行过同时实施世卫组织推荐的整套干预措施的试验。目前提交的文件试图通过将埃塞俄比亚的社区随机分配到一揽子卫生干预措施或标准护理来填补这一空白。在试验中，所有社区都将接受单剂口服阿奇霉素。随机接受卫生包的社区将获得水井、厕所和洗脸教育。随机接受标准护理的社区将获得政府提供的当前卫生促进服务。该试验的共同主要结果是基线访视后 36 个月时临床沙眼和眼衣原体患病率的改善。次要结果包括定量 PCR 的衣原体载量和鼻咽肺炎球菌大环内酯耐药性。将进行成本效益分析，以使沙眼项目能够更好地决定如何使用其有限的资源。相关性（参见说明）：沙眼仍然是全世界导致失明的主要传染性原因。沙眼在贫困地区最常见，卫生条件差被认为是一个促成因素。然而，尚无临床试验证明改善公共卫生和卫生对沙眼有效。该试验旨在提供更有力的证据基础，以指导沙眼控制非抗生素措施的决策。