Country trachoma control programs are currently mass treating trachoma endemic communities every year using single dose azithromycin, with no evidence base for how long treatment must continue to reach these goals, or the optimal clinical marker with which to monitor progress.The World Health Organization currently suggests using follicular trachoma (TF)for monitoring, but data suggest this is sub-optimal. This proposal addresses the following critical aims for national programs: first, we determine the prevalence of infection in Tanzanian communities after exposure to mass treatment for 3 to 7 years, and whether an optimal number of yearly rounds can be identified after which mass treatment could be reconsidered. Second, we assess the utility and predictive value of specific combinations of clinical trachoma signs, following rounds of mass treatment, that might be used to chart progress and guide decisions to stop mass treatment. Working with the Tanzania National Trachoma Control Program communities, we propose to survey samples within 18 communities in each of five strata, reflecting exposure to 3, 4, 5, 6, and 7 rounds of mass treatment. Within the 90 communities, a random sample of children age 1-7 years will be selected to serve as a sentinel sample of current status of trachoma and infection with ocular C. trachomatis, according to years of exposure to mass treatment. Analyses, using models adjusted for clustering of infection within villages, will determine the prevalence of infection as a function of years of exposure to mass treatment, treatment coverage over time, baseline prevalence of trachoma, and other village level predictors. Within strata of exposure to rounds of mass treatment, the utility of other clinical markers against infection, compared to the WHO-recommended use of TF alone against infection, will be assessed. The results are critical for National Trachoma Programs, who need a better understanding of infection in their communities following several rounds of mass treatment and better clinical markers to guide decisions of when to stop mass treatment.

Agency
National Institute of Health (NIH)
Institute
National Eye Institute (NEI)
Type
Research Project (R01)
Project #
3R01EY016429-01A1S1
Application #
7390968
Study Section
Special Emphasis Panel (ZRG1-HOP-Q (90))
Program Officer
Everett, Donald F
Project Start
2006-09-30
Project End
2009-09-29
Budget Start
2006-09-30
Budget End
2007-09-29
Support Year
1
Fiscal Year
2007
Total Cost
$59,182
Indirect Cost
Name
Johns Hopkins University
Department
Ophthalmology
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
West, Sheila K; Munoz, Beatriz; Mkocha, Harran et al. (2011) Number of years of annual mass treatment with azithromycin needed to control trachoma in hyper-endemic communities in Tanzania. J Infect Dis 204:268-73
Munoz, Beatriz; Stare, Dianne; Mkocha, Harran et al. (2011) Can clinical signs of trachoma be used after multiple rounds of mass antibiotic treatment to indicate infection? Invest Ophthalmol Vis Sci 52:8806-10
Patel, Ilesh; Munoz, Beatriz; Mkocha, Harran et al. (2010) Change in function and spectacle-use 2 months after providing presbyopic spectacles in rural Tanzania. Br J Ophthalmol 94:685-9
Wolle, Meraf A; Munoz, Beatriz; Mkocha, Harran et al. (2009) Age, sex, and cohort effects in a longitudinal study of trachomatous scarring. Invest Ophthalmol Vis Sci 50:592-6
Mkocha, H; Munoz, B; West, S (2009) Trachoma and ocular Chlamydia trachomatis rates in children in trachoma-endemic communities enrolled for at least three years in the Tanzania National Trachoma Control Programme. Tanzan J Health Res 11:103-10
Zack, Rachel; Mkocha, Harran; Zack, Elizabeth et al. (2008) Issues in defining and measuring facial cleanliness for national trachoma control programs. Trans R Soc Trop Med Hyg 102:426-31