Conclusions & Recommendations

The TEC recognized the opportunity the Sayam Forage refugee camp presents to further understand the dynamics of population movement. The Ministry is proposing a review of data from the bordering LGAs of Nigeria and the host district of Diffa where the camp is located, all of which will be surveyed this year. They would also like to treat the whole camp once, followed by ongoing treatment of new arrivals throughout the year in the transit area. TEC noted that assessing prevalence in the camp itself would provide a better measure of ongoing trachoma transmission and recommends a prevalence survey, ideally including assessment of serology and infection.

TEC recommends to the Ministries in Uganda and Kenya to coordinate MDAs and surveys to ensure inclusion of the Turkana migratory populations.

TEC recommends that ASPECT requires review and consideration by the TEC Research Subcommittee for a research designation. TEC recognizes that the allocation of districts to the enhanced monitoring through ASPECT may change. The selection of specific districts requiring the full Zithromax® allocation (95%) will be provided once the protocol has been reviewed and approved by an ethics board.
TEC recommends that the ASPECT trial include a component of intensified MDA coverage to ensure that poor delivery does not affect results.

TEC understands from the Ministry that the conflict is ending and the Ministry and partners are ready to resume activities. It has been 3-4 years since the last treatment and populations have moved and fluctuated. TEC recommends that the areas resume MDA/surveys following their current schedule (once populations can be reconfirmed) and then survey as planned.

The Ministry has requested Zithromax® for Child MDA for “slow progressor” woredas but these do not qualify at this time for modified strategies since they are not persistent or recrudescent. In light of this and due to the Zithromax® shortage, the TEC has determined these do not meet criteria unless in the context of a research trial approved by the TEC Research Subcommittee.

TEC observed that there have been delays of 3-5 years in conducting TIS in some parts of the Region. TEC urges the RHB and partners to conduct TIS where practical and safe.

Given the profile of trachoma data (TF1-9 5-9% and very low TT), TEC recommends the inclusion of dried blood spot collection during future baseline and impact surveys to have a fuller picture of what is happening with trachoma in Afghanistan. This may be discussed as part of developing an overall mapping strategy while also exploring the possibility of collecting samples in the already surveyed endemic areas.

Approvals have been in reserve since 2017 without forward movement in the program. Additionally, the surveys were conducted in 2015, meaning in just a few years this data will be considered “stale”. TEC has placed the requested treatments in reserve pending confirmation of funding and ‘special’ reserve, acknowledging that political will to move the program forward needs to be demonstrated. TEC will require new surveys be conducted to support future drug requests if the MDAs do not take place in 2024.

The TEC’s hearts and thoughts are with the Sudanese program and people during the current conflict and hopes for a swift resolution.
TEC and ITI understands that the medical stores may have been looted and the estimated ~410,000 treatments in-country awaiting 2023 treatments may therefore have been lost. TEC and ITI commit to continue working with the program to ensure that they have the treatments needed when MDA can be resumed.

Because of the “stale” prevalence data in Al Jawf (surveys were conducted in 2013), the TEC has placed the districts in these two EUs in reserve pending confirmation of funding and also ‘special’ concerns. In pre-TEC discussions with the Ministry, they acknowledged that enormous population and political changes have taken place and believe re-surveying would be a very sensible approach. If there is an opportunity to treat in 2023, however, and the program would like to move ahead with MDA, TEC supports this decision.