Conclusions & Recommendations

It is imperative that national programs are involved in the discussions to consider and design more-frequent-than-annual MDA.

Reducing the frequency of trachoma impact surveys while maintaining the current program schedule (annual one-round MDA) will not successfully address the persistence issue, nor will it improve our understanding of what is happening in these districts or decrease overall program costs. TEC recommends that the frequency of TIS and TSS remain unchanged.

During the rich discussion about “persistence”, there was general consensus that there is a need to do something different in “persistent areas” while conducting enhanced monitoring and evaluation to gather data to demonstrate whether these strategies are effective and generalizable to other areas. TEC agreed, however, that a consensus of an operational definition of "persistence" needs to be reached. TEC will discuss what this means for eliciting and approving requests for Zithromax®.

As of January 2021, only 5 districts meet the criteria indicating that they have “skipped” MDA due to COVID-19; therefore, there is little need yet for broad scale mitigation due to COVID-19.

TEC recommends countries to include above guidance in their supervisory tools to further the goal of no choking deaths from Zithromax®.

TEC recommends that ITI work with the Ethiopian study team to develop guidance for observing management of children during MDA to share with all endemic countries currently distributing Zithromax®.

TEC recommends that national programs review their trachoma MDA training materials to ensure that the correct dose of POS is given to all children who are eligible to receive it and that other measures to reduce risk of choking are followed during drug distribution, as described in the revised Zithromax® Management Guide.

TEC congratulates countries that have covered the increased activity costs (to purchase personal protective equipment and increases in per diem, lodging, and fuel costs) through domestic financing. TEC notes that securing domestic financing for this and other program activities is in line with guidance in the new WHO NTD Roadmap.

TEC congratulates the national programs that presented at TEC 23 (Nigeria, Côte d’Ivoire, and Ethiopia) and their partners for their rapid and comprehensive COVID-19 risk prevention during trachoma program activities. TEC encourages other countries to implement stringent COVID-19 risk prevention in their trachoma elimination efforts.

TEC recognizes the difficulty in interpreting the survey results in Korhogo, where baseline surveys were conducted at the same time as administrative redistricting resulting in a poor match of survey evaluation units and administrative districts. TEC approved the application for one round of MDA followed by impact surveys for the entirety of each of the new Korhogo districts (Korhogo 1, Korhogo 2, Dikodougou, Mbengue, Sinematiali). The TEC recommends to the NTD program of Côte d’Ivoire that impact surveys be conducted along the new administrative unit structures and not the previous survey evaluation units.