Conclusions & Recommendations

TEC congratulated those involved with the Ethiopian study of compliance with Zithromax® dosing guidance for the wonderfully informative analysis and presentation. TEC were encouraged by the results indicating that more than 99.5% of children aged 5-6 years received powder for oral suspension (POS) in accordance with the revised guidance.

TEC recommends that national programs review their trachoma MDA training materials to ensure that the correct dose of POS is given to all children who are eligible to receive it and that other measures to reduce risk of choking are followed during drug distribution, as described in the revised Zithromax® Management Guide.

TEC recommends that ITI work with the Ethiopian study team to develop guidance for observing management of children during MDA to share with all endemic countries currently distributing Zithromax®.

TEC recommends countries to include above guidance in their supervisory tools to further the goal of no choking deaths from Zithromax®.

As of January 2021, only 5 districts meet the criteria indicating that they have “skipped” MDA due to COVID-19; therefore, there is little need yet for broad scale mitigation due to COVID-19.

During the rich discussion about “persistence”, there was general consensus that there is a need to do something different in “persistent areas” while conducting enhanced monitoring and evaluation to gather data to demonstrate whether these strategies are effective and generalizable to other areas. TEC agreed, however, that a consensus of an operational definition of "persistence" needs to be reached. TEC will discuss what this means for eliciting and approving requests for Zithromax®.

Reducing the frequency of trachoma impact surveys while maintaining the current program schedule (annual one-round MDA) will not successfully address the persistence issue, nor will it improve our understanding of what is happening in these districts or decrease overall program costs. TEC recommends that the frequency of TIS and TSS remain unchanged.

It is imperative that national programs are involved in the discussions to consider and design more-frequent-than-annual MDA.

As a whole, as the global trachoma program matures, more context-specific interventions will be needed.

TEC acknowledges with appreciation the hard work of the ITI team to prepare an organized and well-executed first virtual TEC meeting.