Primary and Secondary Effects of Mass Antibiotic Distributions for Trachoma

摘要 我申请K23职业发展奖有两个目的：1。来增进我们对 通过对人群进行深入分析， 沙眼表面上已经被消除，通过评估大量抗生素的积极副作用， 儿童发病率和死亡率的治疗; 2.发展我作为独立调查员的职业生涯 通过在发展中国家的教学、指导和实践研究经验。我将受益于 两项临床试验的基础设施：TANA（北方阿姆哈拉沙眼改善，U10 EY 016214）和 PRET（Partnership for the Rapid Elimination of Trachoma，Gates Foundation，#48027）。世界卫生组织发起 GET 2020（到2020年全球消除沙眼）计划，以消除致盲性沙眼， 然而，这些目标尚未实现，特别是在高流行社区。大规模治疗已经 在几次消除运动中使用，并发现有意想不到的副作用。 我有以下具体目标： SA 1：确定C.使用基于rRNA的核酸扩增可以消除沙眼感染 与基于DNA的测试相比。 SA 2a：为了确定阿奇霉素治疗是否能降低1-5奥尔兹腹泻、呼吸道感染和腹泻的死亡率， 疾病和疟疾。 SA 2b：确定阿奇霉素治疗是否影响身高、体重和臂围的增加。 我的目标是确定在高流行社区是否可以实现完全消除，然后将其转化为 这些研究结果很快就在沙眼项目和世界卫生组织的全球生殖道传染病防治项目中得到了应用 特别是2020年计划。生长指数是确定质量效应的常用方法 治疗;开发和测试一种测量生长和营养的仪器将提供一个重要的 为今后关于沙眼与其他被忽视的热带病（NTD）的整合研究搭建桥梁。

Abstract I have two objectives in seeking a K23 career development award: 1. to improve our understanding of the effects of mass antibiotic distributions for trachoma by conducting an in depth analysis of populations in which trachoma has ostensibly been eliminated and by assessing the positive secondary effects of mass antibiotic treatments on childhood morbidity and mortality; 2. to develop my career as an independent investigator through didactics, mentorship and hands-on research experience in the developing world. I will benefit from the infrastructure of two clinical trials: TANA (Trachoma Amelioration in Northern Amhara, U10 EY016214) and PRET (Partnership for the Rapid Elimination of Trachoma, Gates Foundation, #48027). The WHO launched the GET 2020 (Global Elimination of Trachoma by the year 2020) program to eliminate blinding trachoma, however, the goals have not been met, particularly in hyperendemic communities. Mass treatments have been used in several elimination campaigns and have been found to have unintended secondary effects. I have the following specific aims: SA1: To determine if C. trachomatis infection can be eliminated using rRNA-based nucleic acid amplification compared to DNA-based testing. SA2a: To determine if azithromycin treatments reduce mortality in 1-5 year olds from diarrhea, respiratory disease and malaria. SA2b: To determine if azithromycin treatments effect increases in height, weight, and arm circumference. My goal is to determine if complete elimination is attainable in hyperendemic communities and then to translate these research findings quickly into practice within trachoma programs in general and within the WHO GET 2020 program in particular. Growth indices are a common method for determining the efficacy of mass treatment; developing and testing an instrument for measuring growth and nutrition will provide an important bridge to future studies on integration of trachoma with other neglected tropical diseases (NTD).