Azithromycin Reduction to Reach Elimination of Trachoma

项目摘要/摘要 每年大量分配阿奇霉素可显著降低衣原体眼部劳损的患病率 导致致盲沙眼的沙眼。目前世界卫生组织的指导方针表明，每年 阿奇霉素的大规模分布应继续，直到地区级流行的临床体征 沙眼，沙眼炎症滤泡(Tf)，下降到5%以下。然而，Tf的相关性并不好。 经多轮阿奇霉素治疗后出现感染。具体地说，转移率的任何下降都远远落后于 感染的减少。因此，TF阈值可能会导致抗生素的过度使用和稀缺资源的枯竭 资源。在这里，我们提出了一项社区随机对照试验和诊断试验研究来评估 1)阿奇霉素是否可以在TF患病率高达20%的社区停止分发；以及2) 沙眼传播的替代指标可以更好地衡量真正的感染情况。我们预计，结果将是 提供证据支持更早停止阿奇霉素治疗，并提供真正的局部证据 可以实现消除感染，将沙眼计划的目标从控制改变为根除。

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.