TEC 22: Compensating for delayed/skipped trachoma treatments (mitigation)
Current modelling data predicts that for the majority of trachoma-endemic districts, skipping a round of MDA (i.e., up to 24 months between treatment rounds) will not have a significant negative effect on disease elimination. However, in hyper-endemic districts (defined in the models as TF1-9 ≥40% at baseline), the models predict that skipping a round of MDA could add 2-3 years to the elimination timeline. Further, annual MDA has usually not been successful in controlling trachoma in these areas.
The results of some past clinical trials demonstrate that multiple rounds of MDA targeting children may be more successful in controlling trachoma in hyper-endemic areas than standard annual treatment (though this was not studied in the context of mitigation).
The TEC would welcome requests for operational research on mitigating the effects of skipped treatments in hyper-endemic districts by conducting multiple rounds of MDA in a year with enhanced surveillance. Such proposals should fit the country context, receive country ethical and regulatory approval, and be consistent with MOH/partner resource availability (political will, financial and human resources, and community acceptance).
This recommendation was further considered during the TEC 23 meeting and at a meeting of TEC members and invited experts on May 11th, 2021. An update will be provided at the TEC 24 meeting.