Conclusions & Recommendations

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.

In light of REACH Network research on the potential benefits of azithromycin for pregnant and intrapartum women, TEC requests that ITI review relevant sections of the revised program manager’s manual, soon to be published, to align it with, and provide references to, these latest research findings.

In light of inherent program delays in conflict areas, the TEC requests that ITI review available data to determine which areas of insecurity might qualify for a modified MDA strategy regardless of meeting the persistent or recrudescent TF criteria, and discuss ways to implement this option with the Ministry of Health and partners.

TEC expresses gratitude to ITI for its work to develop a new application process that enhances interaction with country program managers, streamlines deliberations at TEC meetings, and provides earlier drug demand estimates for forecasting. TEC looks forward to further updates on the application process in preparation for TEC 33 and request that ITI clearly communicate application process changes to countries and partners in advance of TEC 33. TEC requests ITI to ensure that changes to the drug application are clearly communicated to countries and partners in advance of TEC 33.

TEC recommends that ITI work with the national program and partners to strategize how to move the program forward by clarifying roles and responsibilities and addressing funding gaps.

A recent TSS in Tahoua Madoua 1 returned a TF1-9 prevalence of 7.03% and the national program is requesting azithromycin to conduct more frequent than annual MDA - two rounds in 2024. TEC noted, however, that children ages 1 to 59 months are already planned to receive azithromycin for child survival twice per year in this region starting in Fall 2024. Further, this area benefits from seasonal malaria chemoprophylaxis with a sulfadoxine antibiotic 4 times per year (monthly during malaria transmission season). While TEC recognizes that the district meets criteria for trachoma MDA, given that this district will already be receiving other antibiotic treatments in the same timeframe, TEC recommends Niger not to conduct trachoma-specific MDA in 2024 and instead conduct a TIS+ at least six months following the second child survival MDA.

TEC was encouraged to learn that some areas of Amhara are now accessible for the resumption of program activities. Through a detailed woreda-level consideration of security status, TEC was able to move treatments for 28 woredas (4,250,387 treatments) from ‘Reserve pending security’ to ‘Approved for MDA’ in 2024. ITI’s supply chain team is working to get 2024 shipments to Ethiopia and will include treatments for these areas, pending the FMOH returning the signed waiver letter along with the remaining elements of the greenlight checklist.

TEC recommends to the Amhara RHB and partners that in addition to the routine collection of ocular swabs for Ct infection in children, ocular swabs should also be collected from a representative sample of adults aged 15 years and above in woredas that have had 7 or more rounds of MDA to determine whether there is detectable ocular chlamydia in adults.