Kebele Elimination of Trachoma for Ocular Health

7项目摘要/摘要 世界卫生组织(WHO)沙眼项目旨在消除沙眼作为一种公共卫生 到2020年令人担忧--严格地说，这将是一个控制计划，因为感染并未被消除。这个 世卫组织建议在已测量患病率的地区每年大规模分发三至五次阿奇霉素 滤泡性沙眼(Tf)在10%以上，重新评估前。然而，尽管长达十年的时间 阿奇霉素的年度大规模分布，在埃塞俄比亚阿姆哈拉部分地区的TF患病率仍保持在25%以上。 消除感染，定义为将感染的发病率降至零的特定定义 地理区域，是可行的，实际上可能比控制更可持续，因为它可能不太可能 在一个已经实现零新感染的社区中，感染将重新出现。在这里，我们建议测试两个 以抗生素为基础的替代战略，密集瞄准核心群体，以实现在kebele消除 (行政单位由~15个村或开发小组组成)一级。我们提出了一个三臂集群 一项随机试验，以测试(1)所有0-9岁儿童的季度治疗加上年质量 眼部沙眼衣原体感染的0~9岁儿童眼内阿奇霉素分布 加上每年大量使用阿奇霉素，眼部衣原体的患病率较低，并在 与(3)世界卫生组织推荐的阿奇霉素年度大剂量单独分布进行比较。结果是 这项试验有望带来基于抗生素的替代策略的证据，这些策略可能更可靠地导致 在比一个村庄更大的地理区域内完成消除。

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.