Conclusions & Recommendations

A baseline survey in Uror (Jonglei) indicated TF1-9 prevalence of 52.8% (in 2022), warranting up to seven rounds of MDA. By starting treatment in 2024 (round 1), this area will not complete treatments and be ready for TIS until 2030. This situation also applies in Pigi (2023 baseline TF1-9 prevalence of 46.0%) and Pibor/Boma (2023 TIS showing TF1-9 prevalence of 40.2%); starting round one in 2025 would mean they will not complete their fifth round until 2029 in both counties. Recognizing that these areas are not defined as having persistent TF, TEC recommends that the Ministry of Health consider a modified strategy (i.e., MFTA) to accelerate progress and reflect this in their TAP and future drug requests.

Recognizing the program is on hold and ITI is unable to ship treatments, if there is not a signed MOU by the end of August 2024 TEC recommends that ITI consider a high-level delegation visit to the Ministry of Health with implementing partners to pursue execution of the MOU.

TEC recommends that the Kenya and Tanzania National Programs identify transnational EUs that warrant cross-border interventions and develop a workplan to meet shared goals.

TEC recommends that the Kenya and Uganda National Programs identify transnational EUs that warrant cross-border interventions and develop a workplan to meet shared goals.

TEC noted that the security situation in Oromia is rapidly changing and it will be important for partners to support the RHB to conduct program activities as areas become accessible. There are 158 woredas pending impact surveys - the results of which could vastly change program plans and funding requirements for this region. TEC recommends that given the recent security improvements in most parts of Oromia region, ITI work with the MoH and Oromia Regional Health Bureau to re-evaluate the security situation in all districts that are currently labeled as having security issues so that drug can be made available where survey data indicate that MDA needs to be continued.

TEC was encouraged to learn that some areas of Amhara are now accessible for the resumption of program activities. Through a detailed woreda-level consideration of security status, TEC was able to move treatments for 28 woredas (4,250,387 treatments) from ‘Reserve pending security’ to ‘Approved for MDA’ in 2024. ITI’s supply chain team is working to get 2024 shipments to Ethiopia and will include treatments for these areas, pending the FMOH returning the signed waiver letter along with the remaining elements of the greenlight checklist.

TEC recommends to the Amhara RHB and partners that in addition to the routine collection of ocular swabs for Ct infection in children, ocular swabs should also be collected from a representative sample of adults aged 15 years and above in woredas that have had 7 or more rounds of MDA to determine whether there is detectable ocular chlamydia in adults.

A recent TSS in Tahoua Madoua 1 returned a TF1-9 prevalence of 7.03% and the national program is requesting azithromycin to conduct more frequent than annual MDA - two rounds in 2024. TEC noted, however, that children ages 1 to 59 months are already planned to receive azithromycin for child survival twice per year in this region starting in Fall 2024. Further, this area benefits from seasonal malaria chemoprophylaxis with a sulfadoxine antibiotic 4 times per year (monthly during malaria transmission season). While TEC recognizes that the district meets criteria for trachoma MDA, given that this district will already be receiving other antibiotic treatments in the same timeframe, TEC recommends Niger not to conduct trachoma-specific MDA in 2024 and instead conduct a TIS+ at least six months following the second child survival MDA.

TEC recommends that ITI work with the national program and partners to strategize how to move the program forward by clarifying roles and responsibilities and addressing funding gaps.

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).

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.

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.