Conclusions & Recommendations

TEC appreciated the update on the development of the application of model-based geospatial statistics in trachoma programs and looks forward to further validation and information on its application.

TEC is heartened that Sudan is actively planning to restart MDA in three districts that they deem safe. The national program is asking for a full (95%) allocation instead of the reduced (80%) allocation. TEC noted the following:
- funding is confirmed and the implementing partner is The Carter Center;
- due to migration as a result of active conflict, the population figures will need to be re-estimated prior to the next shipment;
- the security situation must be reassessed right up until the moment of shipment;
- these are persistent districts and, therefore, eligible for a modified MDA treatment strategy; however, TEC also noted that the request for 95% of the drug did not seem to be based on a modified strategy request, but instead, on assumptions that the population is greater than current population estimates suggest;
- while the Khartoum airport has been demolished, other humanitarian shipments are successfully being received at Port Sudan and could be moved by road in convoy to the treatment areas. ITI will need to organize a test shipment since this is a new shipment location.
TEC recommends that:
- a pre-treatment census in the camps be conducted to finalize treatment figures,
- a reduced (80%) allocation be given consistent with other countries, and
- the treatment requests be approved pending confirmation of security (RS).

The TEC recognized the opportunity the Sayam Forage refugee camp presents to further understand the dynamics of population movement. The Ministry is proposing a review of data from the bordering LGAs of Nigeria and the host district of Diffa where the camp is located, all of which will be surveyed this year. They would also like to treat the whole camp once, followed by ongoing treatment of new arrivals throughout the year in the transit area. TEC noted that assessing prevalence in the camp itself would provide a better measure of ongoing trachoma transmission and recommends a prevalence survey, ideally including assessment of serology and infection.

TEC recommends to the Ministries in Uganda and Kenya to coordinate MDAs and surveys to ensure inclusion of the Turkana migratory populations.

TEC recommends that ASPECT requires review and consideration by the TEC Research Subcommittee for a research designation. TEC recognizes that the allocation of districts to the enhanced monitoring through ASPECT may change. The selection of specific districts requiring the full Zithromax® allocation (95%) will be provided once the protocol has been reviewed and approved by an ethics board.
TEC recommends that the ASPECT trial include a component of intensified MDA coverage to ensure that poor delivery does not affect results.

TEC understands from the Ministry that the conflict is ending and the Ministry and partners are ready to resume activities. It has been 3-4 years since the last treatment and populations have moved and fluctuated. TEC recommends that the areas resume MDA/surveys following their current schedule (once populations can be reconfirmed) and then survey as planned.

The Ministry has requested Zithromax® for Child MDA for “slow progressor” woredas but these do not qualify at this time for modified strategies since they are not persistent or recrudescent. In light of this and due to the Zithromax® shortage, the TEC has determined these do not meet criteria unless in the context of a research trial approved by the TEC Research Subcommittee.

TEC observed that there have been delays of 3-5 years in conducting TIS in some parts of the Region. TEC urges the RHB and partners to conduct TIS where practical and safe.

Given the profile of trachoma data (TF1-9 5-9% and very low TT), TEC recommends the inclusion of dried blood spot collection during future baseline and impact surveys to have a fuller picture of what is happening with trachoma in Afghanistan. This may be discussed as part of developing an overall mapping strategy while also exploring the possibility of collecting samples in the already surveyed endemic areas.

Approvals have been in reserve since 2017 without forward movement in the program. Additionally, the surveys were conducted in 2015, meaning in just a few years this data will be considered “stale”. TEC has placed the requested treatments in reserve pending confirmation of funding and ‘special’ reserve, acknowledging that political will to move the program forward needs to be demonstrated. TEC will require new surveys be conducted to support future drug requests if the MDAs do not take place in 2024.