Conclusions & Recommendations

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.

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.