Conclusions & Recommendations

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.

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.

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.

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.

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.

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 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.

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 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.

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.