TEC 22: Compensating for delayed/skipped trachoma treatments (mitigation)

Recommendation:

Current modelling data predicts that for the majority of trachoma-endemic districts, skipping a round of MDA (i.e., up to 24 months between treatment rounds) will not have a significant negative effect on disease elimination. However, in hyper-endemic districts (defined in the models as TF1-9 ≥40% at baseline), the models predict that skipping a round of MDA could add 2-3 years to the elimination timeline. Further, annual MDA has usually not been successful in controlling trachoma in these areas.

The results of some past clinical trials demonstrate that multiple rounds of MDA targeting children may be more successful in controlling trachoma in hyper-endemic areas than standard annual treatment (though this was not studied in the context of mitigation).

The TEC would welcome requests for operational research on mitigating the effects of skipped treatments in hyper-endemic districts by conducting multiple rounds of MDA in a year with enhanced surveillance. Such proposals should fit the country context, receive country ethical and regulatory approval, and be consistent with MOH/partner resource availability (political will, financial and human resources, and community acceptance).

Action:

This recommendation was further considered during the TEC 23 meeting and at a meeting of TEC members and invited experts on May 11th, 2021. An update will be provided at the TEC 24 meeting.

TEC 22: Zithromax® Supply Chain in the time of COVID-19

Recommendation:

TEC recommends continued adherence to the “enhanced” greenlight checklist while the pandemic continues. ITI Supply Chain will re-confirm availability of funds with the donor and timing of MDA with the MOH prior to all shipments.

Action:

This has continued to be a standard operating procedure with all Zithromax®️ shipments.

TEC 22: Additional fine-tuning needed regarding decision making for treatment of refugee camps/IDPs

Recommendation:

• TEC notes that there is continued difficulty in making evidence-based decisions in the context of refugees and internally-displaced persons (IDPs), which indicates the need for clarification of the decision-making guidelines

• The TEC considered whether a survey in a fluid population provides any actionable information; and recognizes other methodologies that allow more flexibility and context-specific data capture may be needed. The experience of other programs working in similar situations may be instructive to the trachoma community in determining the necessary indicators to allow ITI to determine the point when MDA with Zithromax® is no longer needed.

• The TEC Refugee/IDP Committee will think through these issues and bring thinking to the next TEC meeting for further consideration, particularly around the issue of data gathering in these populations. The Committee is now comprised of Chad, Robin, Stephanie, and David.

Action:

A sub-committee meeting is tentatively planned for May 27th.