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Conclusions & Recommendations

Communication Outside of TEC Meeting

Outside Comm. - Inclusion of new refugee camp in Gambella MDAs

Conclusion/Recommendation:

Africa - East

Nyunyeil Camp was created after prevalence surveys were completed in the other camps in Gambella. The new camp is housing refugees from the same place of origin as the existing camps. The refugees' place of origin and host communities were both trachoma endemic. The FMOH reqeusted to treat the new camp without conducting additional surveys. The TEC liaison approved this request.

Ethiopia

Action:

special populations, evaluation units, Zithromax® donation criteria

TEC 30

30.12.1 - Consideration of Sudan’s request to restart MDA with a full allocation

2023

Conclusion/Recommendation:

Eastern Mediterranean

TEC is heartened that Sudan is actively planning to restart MDA in three districts that they deem safe. The national program is asking for a full (95%) allocation instead of the reduced (80%) allocation. TEC noted the following:
- funding is confirmed and the implementing partner is The Carter Center;
- due to migration as a result of active conflict, the population figures will need to be re-estimated prior to the next shipment;
- the security situation must be reassessed right up until the moment of shipment;
- these are persistent districts and, therefore, eligible for a modified MDA treatment strategy; however, TEC also noted that the request for 95% of the drug did not seem to be based on a modified strategy request, but instead, on assumptions that the population is greater than current population estimates suggest;
- while the Khartoum airport has been demolished, other humanitarian shipments are successfully being received at Port Sudan and could be moved by road in convoy to the treatment areas. ITI will need to organize a test shipment since this is a new shipment location.
TEC recommends that:
- a pre-treatment census in the camps be conducted to finalize treatment figures,
- a reduced (80%) allocation be given consistent with other countries, and
- the treatment requests be approved pending confirmation of security (RS).

Sudan

Action:

insecurity, special populations, persistence

TEC 30

30.11.1 - Use of model-based geospatial statistics in Tropical Data

2023

Conclusion/Recommendation:

TEC appreciated the update on the development of the application of model-based geospatial statistics in trachoma programs and looks forward to further validation and information on its application.

Action:

alternative indicators (Ct, serology)

TEC 30

30.10.1 - Sentinel site monitoring of annual vs. biannual MDA in Tanzania

2023

Conclusion/Recommendation:

Africa - East

TEC expresses their appreciation for the work led by Dr. George Kabona, the MOH of Tanzania, and its partners who quickly put into effect an enhanced monitoring strategy. TEC looks forward to additional updates as data become available.

Tanzania

Action:

research, alternative indicators (Ct, serology)

TEC 30

30.09.1 - Zambia

2023

Conclusion/Recommendation:

Africa - Central/Southern

TEC congratulates the Zambia program for their excellent work during their recent surveys, particularly in the decision to add the collection of complementary indicators in Kaoma, Luampa, and Nkeyema. TEC is grateful for the fast and diligent work in developing a comprehensive and well thought out plan for how to move forward in the three evaluation units categorized as “persistent” districts. TEC recommends:
- In Kaoma, Luampa, and Nkeyema, given the inconsistency between TF1-9 of 9.16% and a seroconversion rate among children 1-5 years of 0.6%, PCR processing of the already collected conjunctival swabs will provide important information to inform program activities. TEC looks forward to receiving the Ct infection results in due course and a further discussion with the program on next steps in these districts. TEC contingently approves the request for these three districts pending review of Ct infection results and confirmation of funding (R2/R1).
- In Shangombo and Sioma where TF1-9 is 12.5%, TEC approves the request for a modified strategy of two treatments 5 months apart (projected for May and October 2024), pending confirmation of funding (R1), followed by a TIS+ including both serology and infection data collection, subject to available funding.
- In Sikongo and Kalabo where TF1-9 is 7.7%, TEC recommends to ITI to hold further discussions with the Ministry of Health and program partners to discuss recent evidence from the trachoma community on areas with TF1-9 5-9% at the endgame, and explain all options available to the program (including timelines and cost implications) for their consideration. These districts are eligible for the modified MDA strategy proposed by the national program, and if the MOH determines this is the best strategy for their situation, TEC will approve the drug (contingent on confirmation of MDA funding). If, instead, the MOH prefers to adopt an enhanced monitoring strategy (e.g., ‘wait and watch’ followed by a TIS+), TEC and ITI stand ready to provide the program with any technical assistance that they may need, if requested.

Zambia

Action:

persistence, evaluation units, end game

TEC 30

30.08.1 - Application of complementary indicators for program decision making

2023

Conclusion/Recommendation:

Given how quickly data are being generated and trachoma program guidance is changing, TEC recommends that ITI discuss with WHO how best to support the convening of a meeting of program managers in countries with persistent/recrudescent districts to disseminate recent findings and help them understand the range of options for how best to move their programs forward.

Action:

alternative indicators (Ct, serology)

TEC 30

30.07.1 - Three is better than two

2023

Conclusion/Recommendation:

TEC has been impressed by the incorporation of complementary indicators for trachoma, and encourages continued inclusion when appropriate. TEC also noted considerable interest in other measures of infection beyond serology. In fact, open meeting discussion noted advantages of having a direct measure of infection, which responds more rapidly to intervention, and could act as a “tie-breaker” when results from district-level TF and serology are inconsistent. Several examples of PCR being used constructively in certain settings were presented. PCR would be an obvious candidate for a third complementary indicator.

Action:

alternative indicators (Ct, serology), research

TEC 30

30.06.1 - Collection and use of infection at scale

2023

Conclusion/Recommendation:

TEC congratulates the Federal Ministry of Health of Ethiopia, Amhara Regional Health Bureau, Amhara Public Health Institute, and The Carter Center on the important work they’ve been doing for 10+ years on data collection and analyses supporting the evaluation of the trachoma program.

Action:

alternative indicators (Ct, serology), research

TEC 30

30.05.1 - Serology guideline development

2023

Conclusion/Recommendation:

TEC is grateful for WHO’s swift work to move the guideline development process forward on the use of serology for trachoma assessments. To better support countries’ capacity to utilize serology in their programs, TEC would like to understand the additive costs associated with collection and processing of specimens for serology.
TEC would like to see a similar process for the development of guidelines on the use of infection data so that trachoma programs can benefit from more comprehensive guidance. To support this, TEC would welcome validating large-scale PCR pooling and data on program costs and evidence of comparability across different tests and platforms.

Action:

alternative indicators (Ct, serology)

TEC 30

30.04.1 - REACH

2023

Conclusion/Recommendation:

TEC appreciated the detailed update from the Bill & Melinda Gates Foundation on the REACH trials. As results are coming in and the Foundation expresses its interest in scaling up child survival programs, TEC noted the currently inadequate global POS production capacity and would appreciate future updates and coordination between ITI, Pfizer, TEC, and BMGF on this issue and its impact on the trachoma program’s POS needs. TEC welcomes the possibility of future engagement for child survival rollout and further requests clarification of its own role. Recognizing ITI’s excellence in supply chain management, evidence gathering, leadership, and convening, TEC further advocates for ITI to be the primary steward of azithromycin procured and/or donated for trachoma and child survival. TEC notes that ITI would need additional resources to take on this additional workload while maintaining its excellent support to national trachoma programs.

Action:

research

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