Conclusions & Recommendations

TEC recommends that ITI send acknowledgements to National Programs where districts no longer warrant MDA and have not requested Zithromax®, while acknowledging that many still have TT goals that require further intervention. TEC further recommends that ITI offer technical assistance in dossier development.

TEC recommends that in the Zithromax® Applications, ITI:
-Color the font of TT prevalence greater than threshold in a different color;
-Include cumulative rounds of MDA count pre-2014 as a single column, but maintain the detailed annual breakdown in an electronic version available to TEC members;
-For TEC 19, print only Applications and provide electronic versions of the full TEC book (including detailed Applications);
-For TEC 19, include on the agenda a discussion on “persistent” TF, including:
-Clarity on geographical locations of the observed phenomenon;
-Details on current OR and program efforts already underway;
-Clarity on the questions and how TEC may advise countries

TEC recommends that in light of the Zamfara theft incident, the National Program review its security practices at all state-level drug storage facilities.

TEC recommends to the Federal Ministry of Health (FMOH) and Regional Health Bureaus (RHB) that:
In areas that have started as a single Evaluation Unit (EU)/woreda, and in accordance with WHO’s guidelines on population size for prevalence surveys, recently-split woredas be surveyed as a single EU (comprising the original “parent” district). Note that this does NOT apply to baseline “super districts”, in which multiple woredas were combined to comprise a single EU.

TEC recommends that the FMOH, RHB, and partners should consider including towns in future trachoma prevalence surveys.

In regards to the 2017 Zithromax® shipment being held since October 2017 pending large demurrage charges, TEC recommends and concludes that:
– ITI work with Sightsavers to support The Trust in sending a letter to the President of Kenya, with copy to the Ministry of Health (MOH), Ministry of Finance, and Ministry of Foreign Affairs;
– ITI and Sightsavers consider sending a high-level delegation to follow up in person;
– Additional drug (2018 shipment) is not sent until the clearance issues of the 2017 shipment are resolved (2018 approvals are now in “RS”);
– They will defer consideration of the 2019 Zithromax® Application pending resolution of the 2017 clearance issues.

TEC acknowledges the need to be opportunistic in implementation of MDA, providing service to approved districts when possible.

TEC commends the National Program and its partners for conducting operational research that clearly illustrated that not reaching nomadic populations was an obstacle to achieving elimination targets.

Given the TF and Ct infection data presented for Ngorongoro, Mpwapwa, Longido, Monduli, and others, TEC encourages the MOH to consider submitting a Zithromax® request for targeted treatment to nomadic populations.

Further, TEC recommends consideration of appropriate strategies to determine the disease burden and effectively reach such populations, as recommended during TEC 15.