Conclusions & Recommendations

TEC noted that there was no request for 2021 for the Protection of Civilians (POC) camp located in Juba. The national program has indicated that this is because the camp is due for closure. If the camp is not closed, TEC invites the Ministry to submit a mid-year request after conducting a prevalence survey.

The Ministry of Health of Tanzania submitted a concept note for an operational research project to determine the impact of nomadic populations on persistent disease in specific districts and to develop strategies for more effectively reaching these groups as distinct populations. The TEC Research Subcommittee will review the concept note and provide feedback to the MOH.

The TEC expressed concerns for the internally displaced persons from conflict in Cabo Delgado into trachoma-endemic districts of Nampula. TEC requests more details from the national program about the situation; based on this, the population for these districts may need to be adjusted following the guidelines of the Refugee/IDP algorithm.

TEC recommends continued adherence to the “enhanced” greenlight checklist while the pandemic continues. ITI Supply Chain will re-confirm availability of funds with the donor and timing of MDA with the MOH prior to all shipments.

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).

ITI supports country programs to make their own determination when they are ready to restart field activities (surveys and/or MDA) in the context of the COVID-19 pandemic. ITI stands ready to provide Zithromax® when MDA is restarted.

The TEC reflected on their principle that the Zithromax® donation is based on demonstrated evidence of need. If it is safe to conduct field activities, scheduled impact surveys should be conducted prior to potential MDA so that the normal data-driven process is not interrupted.

TEC recognizes that coronavirus safety adaptations may be required to complete surveys. Such adaptations would ideally be agreed between partners and the Ministry of Health prior to implementation.