Conclusions & Recommendations

The TEC’s hearts and thoughts are with the Sudanese program and people during the current conflict and hopes for a swift resolution.
TEC and ITI understands that the medical stores may have been looted and the estimated ~410,000 treatments in-country awaiting 2023 treatments may therefore have been lost. TEC and ITI commit to continue working with the program to ensure that they have the treatments needed when MDA can be resumed.

Because of the “stale” prevalence data in Al Jawf (surveys were conducted in 2013), the TEC has placed the districts in these two EUs in reserve pending confirmation of funding and also ‘special’ concerns. In pre-TEC discussions with the Ministry, they acknowledged that enormous population and political changes have taken place and believe re-surveying would be a very sensible approach. If there is an opportunity to treat in 2023, however, and the program would like to move ahead with MDA, TEC supports this decision.

TEC was enthusiastic about the new country application from Angola, and are encouraged that there has been solid progress in prevalence surveys and engagement by the Ministry. TEC noted the profile of trachoma in Angola (low TF overall and very low TT), and encourages the addition of serology and/or infection analysis in upcoming baseline surveys, if possible, to more fully understand the situation (particularly in areas bordering Zambia and DRC).

TEC recommends that given that DRC (Bandundu, Kwango, Kajiji and Panzi) is a new site for the ARRET trial, the TEC Research Subcommittee should review the protocol.
TEC noted with concern that DRC had not yet implemented the change to the Zithromax® dosing guidelines communicated to the Ministry in 2018, and that the ITI Supply Chain team had not observed this deviation. TEC is anxious to receive confirmation from the Ministry of Health that all of the recommended steps have been taken prior to resuming the MDAs.
TEC requests that ITI’s Supply Chain team provide enhanced monitoring to TEC for all countries that would enable such deviations to be picked up on in a more timely manner. TEC further requests that the ITI Supply Chain team review the guidelines with all donation recipient countries and ensure that they have implemented the revised dosing guidelines.

While Nacala-a-Velha and Mossuril have TF1-9 <5%, their infection and serology results indicate transmission is likely still ongoing. They are recrudescent districts and have requested a modified strategy of 3 additional annual rounds based on their complementary indicator results. TEC has decided to approve these treatments as a non-precedent setting decision and requests data from a follow-up TIS with collection of complementary indicators. [ITI: include this ‘non-precedent setting’ language in the comments for future applications!!]

TEC heartily congratulates the Ministries of Health of Benin and Mali for the recent WHO validation of elimination of trachoma as a public health problem.

Label of recrudescent and persistent are based on TF and the label of recrudescent should remain until a TSS with TF1-9 <5%.

TEC notes the upcoming serology meeting and awaits with interest the decisions on complementary indicator thresholds to inform future Zithromax allocation decisions.

TEC is encouraged by the research investments by the NTD-SC for trachoma, but was disappointed to learn of the intention not to conduct PCR testing. TEC recommends the eye swabs being collected be PCR processed and results triangulated and shared.

TEC noted with enthusiasm the number of country applications that are fully reserve requests pending impact surveys, which demonstrates enormous progress across the global programme.