Yearly Mass Treatment C. Trachomatis: When Can We Stop?

国家沙眼控制方案目前每年都在大规模治疗沙眼流行社区。 使用单剂量阿奇霉素，没有证据表明治疗必须持续多久才能达到这些 目标，或监测进展的最佳临床标记物。世界卫生组织目前 建议使用滤泡性沙眼(TF)进行监测，但数据显示这是次优的。这项建议 解决国家方案的以下关键目标：首先，我们确定#年的感染率 坦桑尼亚社区在接受3至7年的大规模治疗后，是否有最佳人数 可以确定每年轮次的数量，在此之后可以重新考虑大规模治疗。第二，我们评估 肿块后临床沙眼体征特定组合的实用性和预测价值 治疗，这可能被用来绘制进展图，并指导停止大规模治疗的决定。使用 坦桑尼亚国家沙眼控制计划社区，我们建议在18个月内调查样本 五个阶层中每个阶层的社区，反映接受了3、4、5、6和7轮大规模治疗。在 这90个社区将随机抽取1-7岁的儿童作为哨兵 沙眼和眼部沙眼衣原体感染现状样本，按年份计算 暴露于大规模治疗中。使用针对村庄内感染集群进行调整的模型进行分析，将 确定感染流行率作为接触大规模治疗、治疗的多年的函数 随时间变化的覆盖率、沙眼的基线患病率以及其他村级预测指标。在…的层级内 暴露于几轮大规模治疗中，其他临床标记物对抗感染的有效性，与 将对世卫组织推荐的单独使用TF抗感染进行评估。这一结果对National来说至关重要 沙眼计划，他们需要更好地了解他们社区的感染情况，以下几个 几轮大规模治疗和更好的临床标记，以指导何时停止大规模治疗的决定。

Country trachoma control programs are currently mass treating trachoma endemic communities every year using single dose azithromycin, with no evidence base for how long treatment must continue to reach these goals, or the optimal clinical marker with which to monitor progress.The World Health Organization currently suggests using follicular trachoma (TF)for monitoring, but data suggest this is sub-optimal. This proposal addresses the following critical aims for national programs: first, we determine the prevalence of infection in Tanzanian communities after exposure to mass treatment for 3 to 7 years, and whether an optimal number of yearly rounds can be identified after which mass treatment could be reconsidered. Second, we assess the utility and predictive value of specific combinations of clinical trachoma signs, following rounds of mass treatment, that might be used to chart progress and guide decisions to stop mass treatment. Working with the Tanzania National Trachoma Control Program communities, we propose to survey samples within 18 communities in each of five strata, reflecting exposure to 3, 4, 5, 6, and 7 rounds of mass treatment. Within the 90 communities, a random sample of children age 1-7 years will be selected to serve as a sentinel sample of current status of trachoma and infection with ocular C. trachomatis, according to years of exposure to mass treatment. Analyses, using models adjusted for clustering of infection within villages, will determine the prevalence of infection as a function of years of exposure to mass treatment, treatment coverage over time, baseline prevalence of trachoma, and other village level predictors. Within strata of exposure to rounds of mass treatment, the utility of other clinical markers against infection, compared to the WHO-recommended use of TF alone against infection, will be assessed. The results are critical for National Trachoma Programs, who need a better understanding of infection in their communities following several rounds of mass treatment and better clinical markers to guide decisions of when to stop mass treatment.