Azithromycin Reduction to Reach Elimination of Trachoma

项目概要/摘要 每年大规模分发阿奇霉素可显著降低衣原体眼部菌株的患病率 导致失明的沙眼。目前世界卫生组织的指导方针表明， 应继续大规模分发阿奇霉素，直到地区一级的临床症状普遍存在， 沙眼，即沙眼性炎症-滤泡（TF），下降到5%以下。然而，TF没有很好地相关 阿奇霉素治疗后感染具体来说，TF的任何下降都远远滞后于 减少感染。因此，TF阈值可能导致抗生素的过度使用和稀缺的 资源在这里，我们提出了一个社区随机对照试验和诊断测试研究，以评估 1）在TF患病率高达20%的社区是否可以停止阿奇霉素的销售，以及2） 沙眼传播的替代指标可以更好地衡量真正的感染。我们预计，结果将 提供证据以支持更早停止阿奇霉素治疗，并提供证据表明， 消除感染是可以实现的，将沙眼项目的目标从控制改为根除。

PROJECT SUMMARY/ABSTRACT Annual mass azithromycin distribution dramatically reduces the prevalence of the ocular strains of Chlamydia trachomatis that lead to blinding trachoma. Current World Health Organization guidelines indicate that annual mass azithromycin distribution should be continued until district-level prevalence of the clinical sign of trachoma, trachomatous inflammation-follicular (TF), drops below 5%. However, TF does not correlate well with infection after multiple rounds of azithromycin treatment. Specifically, any decrease in TF lags well behind the decrease in infection. Thus the TF threshold may lead to overuse of antibiotics and depletion of scarce resources. Here, we propose a community randomized controlled trial and diagnostic test study to evaluate whether 1) azithromycin distribution can be discontinued in communities with TF prevalence up to 20%, and 2) alternative indicators of trachoma transmission can better measure true infection. We anticipate that results will provide evidence to support discontinuation of azithromycin treatment earlier, and evidence of that true local elimination of infection can be achieved, altering the goal of the trachoma program from control to eradication.