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 expresses gratitude to ITI for its work to develop a new application process that enhances interaction with country program managers, streamlines deliberations at TEC meetings, and provide earlier drug demand estimates for forecasting. TEC looks forward to further updates on the application process in preparation for TEC 33 and request that ITI clearly communicate application process changes to countries and partners in advance of TEC 33. TEC requests ITI to ensure that changes to the drug application are clearly communicated to countries and partners in advance of TEC 33.

In light of inherent program delays in conflict areas, the TEC requests that ITI review available data to determine which areas of insecurity might qualify for a modified MDA strategy regardless of meeting the persistent or recrudescent TF criteria, and discuss ways to implement this option with the Ministry of Health and partners.

In light of REACH Network research on the potential benefits of azithromycin for pregnant and intrapartum women, TEC requests that ITI review relevant sections of the revised program manager’s manual, soon to be published, to align it with, and provide references to, these latest research findings.

The TEC appreciated the analysis by ITI team members and the TEC complementary indicator working group and their clear presentation of a suggested framework for guiding TEC decisions on drug allocation when complementary indicators are available. TEC recommends that the framework be adopted as a tool for internal use by TEC and ITI on an interim basis, particularly in areas of persistent or recrudescent TF. TEC recommends ongoing collection and analysis of complementary indicators where resources are available to refine decision-making thresholds, and incorporation of updated information into a refined framework. The TEC appreciates efforts by WHO to convene a Guideline Development Group on the use of complementary indicators in trachoma elimination programs and looks forward to incorporating those recommendations into the drug donation decision making algorithm once available.

TEC acknowledges with gratitude Pfizer’s generous commitment and extraordinary efforts to increase their manufacturing capacity for the trachoma program. In light of the restored supply capacity, TEC recommends that the historical approach to allocation (95% of Approved, 100% of Surgery, and 100% of Research) be restored for all 2025 shipments. TEC further recommends that ITI send letters to all partners and countries to notify them of this change.

TEC appreciates the tremendous progress in the use of photography to document TF and TT and to facilitate trachoma elimination. TEC encourages the continued use of the Gondar Grading Center and Tropical Data’s Photo Library.

TEC and ITI have typically considered survey data more than 10 years old to be ‘stale’ and likely no longer representative of current conditions. In response to a question raised during the meeting as to whether a shorter timeframe would be more appropriate, TEC deliberated on the tradeoffs and situational contexts in which this occurs. TEC determined that, as a working internal principle, even in areas where insecurity or high population movement has occurred, data could still be considered valid for up to 10 years and used in support of requests for azithromycin.

Recognizing both the potential advantages and challenges in ‘integrated’ MDA for both trachoma and child survival, as well as the need for more information, TEC recommends that ITI commission a white paper that analyzes the programmatic impact, cost, safety, supply chain, and operational implications of different options for integrated trachoma/child survival MDA. TEC looks forward to engaging in future conversations about how best to achieve integration.

The TEC congratulates the REACH Network on their impressive progress in supporting national programs using azithromycin MDA to reduce child mortality. TEC is committed to support the emerging partnership between the child survival and trachoma communities. TEC reviewed preliminary information on geographic overlap of areas requiring MDA for trachoma elimination and child survival. The TEC encourages national health ministries to explore opportunities for integrating child survival and trachoma MDAs where possible.