Conclusions & Recommendations

TEC encourages the Tanzanian health ministry to consider conducting a TSS+ in Chamwino DC South and Kongwa DC North evaluation units, given their long history of persistent/recrudescent TF. TEC recognizes that incorporating complementary indicator(s) adds time and cost to surveys, albeit with a view to save time and costs in the future by avoiding unnecessary MDA and subsequent surveys, and encourages the Tanzanian health ministry to discuss this recommendation with its partners and donors.

TEC encourages the CAR health ministry to consider conducting surveys that incorporate complementary indicators (“plus” surveys) in Bossangoa and Bouca in 2028 when their next impact survey is due, following completion of their newly-approved modified MDA strategy. TEC recognizes that incorporating complementary indicator(s) adds time and cost to surveys, albeit with a view to save time and costs in the future by avoiding unnecessary MDA and subsequent surveys, and encourages the CAR health ministry to discuss this recommendation with its partners and donors.

TEC noted that activities are sometimes delayed in CAR and further encourages the health ministry to discuss with partners their full funding needs to ensure adequate resources.

TEC noted the recent influx of refugees from Darfur (endemic for trachoma) across the border into Chad. TEC recommends to ITI to follow up with the Chad health ministry to understand the situation in refugee camps and have a dialogue about whether they would be interested in requesting azithromycin to treat refugees in camps where populations from Darfur had a TF prevalence warranting MDA.

TEC further noted that given the incredible progress made in Chad in reducing trachoma prevalence to below elimination thresholds in all other areas of the country, it is very unlikely that there is active ocular C. trachomatis infection remaining in the three districts with TF1-9 ≽5%. Therefore, if funding cannot be identified for implementing MDA in 2025/26, a “wait and see” strategy followed by a survey incorporating complementary indicator(s) is a very reasonable approach.

TEC congratulates the national program of Senegal on reaching the important milestone of completing their dossier for the validation of the elimination of trachoma as a public health problem. The strong political engagement displayed by the Senegal program in the fight against NTDs is well noted. TEC looks forward to hearing that the dossier has been submitted and validated by WHO.

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.