Conclusions & Recommendations

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.

TEC is committed to managing the Zithromax® shortage applying the principles of equity, transparency, and data-driven defensibility. The current allocation approach (80% of Approved; 100% of Surgery; and 95% of Research) will be kept the same for now. Pfizer is actively working to address the supply challenges; however, in the short term, a shortfall will remain resulting in the need for additional reductions to demand and/or delayed shipments. The TEC and ITI are committed to communicating additional information as it becomes available, which may lead to a need to call an extraordinary meeting between TEC, Pfizer, and key partners and donors to address these challenges together.

While drug supplies remain low, TEC encourages consideration of targeting children only following community-wide MDA in areas conducting more frequent than annual treatments.

TEC noted with enthusiasm the number of country applications that are fully reserve requests pending impact surveys, which demonstrates enormous progress across the global programme.

TEC is encouraged by the research investments by the NTD-SC for trachoma, but was disappointed to learn of the intention not to conduct PCR testing. TEC recommends the eye swabs being collected be PCR processed and results triangulated and shared.

TEC notes the upcoming serology meeting and awaits with interest the decisions on complementary indicator thresholds to inform future Zithromax allocation decisions.

Recommendation to ITI: “Persistent” label of recrudescent and persistent are based on TF and the label of recrudescent should remain until a TSS with TF1-9 <5%.

TEC heartily congratulates the Ministries of Health of Benin and Mali for the recent WHO validation of elimination of trachoma as a public health problem.

While Nacala-a-Velha and Mossuril have TF1-9 <5%, their infection and serology results indicate transmission is likely still ongoing. They are recrudescent districts and have requested a modified strategy of 3 additional annual rounds based on their complementary indicator results. TEC has decided to approve these treatments as a non-precedent setting decision and requests data from a follow-up TIS with collection of complementary indicators.

TEC recommends that given that DRC (Bandundu, Kwango, Kajiji and Panzi) is a new site for the ARRET trial, the TEC Research Subcommittee should review the protocol.
TEC noted with concern that DRC had not yet implemented the change to the Zithromax® dosing guidelines communicated to the Ministry in 2018, and that the ITI Supply Chain team had not observed this deviation. TEC is anxious to receive confirmation from the Ministry of Health that all of the recommended steps have been taken prior to resuming the MDAs.
TEC requests that ITI’s Supply Chain team provide enhanced monitoring to TEC for all countries that would enable such deviations to be picked up on in a more timely manner. TEC further requests that the ITI Supply Chain team review the guidelines with all donation recipient countries and ensure that they have implemented the revised dosing guidelines.