Conclusions & Recommendations

TEC reviewed the experience of national trachoma programs in areas that completed trachoma MDA and are awaiting impact or surveillance surveys, while also being targeted for MDA for child survival. Noting the validation requirement for a two-year antibiotic MDA free period before a TSS is in tension with the ethical mandate of MDA for child survival, TEC requested that WHO provide relevant guidance to affected countries.

TEC appreciated the progress in developing innovative ways to assess the need for intervention in areas of conflict, and encouraged ongoing development of methods to assess the need for, and deliver interventions in, areas of conflict. Options for this may include using local teams to conduct surveys, simultaneously collecting complementary indicators, and using paper-based surveys.

The TEC reviewed data on trachoma impact surveys that have been delayed due to conflict and other factors. Such delays can postpone submission of the national dossier and thus the validation of the elimination of trachoma as a public health problem. When the recommended number of MDA rounds has been completed and trachoma impact surveys are delayed by more than 2.5 years, national programs may wish to consult WHO on whether such an impact survey may serve the function of a trachoma surveillance survey if the TF prevalence is <5%.

In areas where trachoma impact surveys have been delayed for more than 2.5 years since MDA and the new TIS results indicate TF above threshold, TEC would consider a request from national programs for a drug donation for a modified MDA strategy (even if the district did not previously qualify as 'persistent' or 'recrudescent').

The TEC congratulates the REACH Network on their impressive progress in supporting national programs using azithromycin MDA to reduce child mortality. TEC is committed to support the emerging partnership between the child survival and trachoma communities. TEC reviewed preliminary information on geographic overlap of areas requiring MDA for trachoma elimination and child survival. The TEC encourages national health ministries to explore opportunities for integrating child survival and trachoma MDAs where possible.

Recognizing both the potential advantages and challenges in ‘integrated’ MDA for both trachoma and child survival, as well as the need for more information, TEC recommends that ITI commission a white paper that analyzes the programmatic impact, cost, safety, supply chain, and operational implications of different options for integrated trachoma/child survival MDA. TEC looks forward to engaging in future conversations about how best to achieve integration.

TEC and ITI have typically considered survey data more than 10 years old to be ‘stale’ and likely no longer representative of current conditions. In response to a question raised during the meeting as to whether a shorter timeframe would be more appropriate, TEC deliberated on the tradeoffs and situational contexts in which this occurs. TEC determined that, as a working internal principle, even in areas where insecurity or high population movement has occurred, data could still be considered valid for up to 10 years and used in support of requests for azithromycin.

TEC appreciates the tremendous progress in the use of photography to document TF and TT and to facilitate trachoma elimination. TEC encourages the continued use of the Gondar Grading Center and Tropical Data’s Photo Library.

TEC acknowledges with gratitude Pfizer’s generous commitment and extraordinary efforts to increase their manufacturing capacity for the trachoma program. In light of the restored supply capacity, TEC recommends that the historical approach to allocation (95% of Approved, 100% of Surgery, and 100% of Research) be restored for all 2025 shipments. TEC further recommends that ITI send letters to all partners and countries to notify them of this change.

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.