Dataset Information

A randomized trial of two coverage targets for mass treatment with azithromycin for trachoma.

ABSTRACT: The World Health Organization recommends at least 3 annual antibiotic mass drug administrations (MDA) where the prevalence of trachoma is > 10% in children ages 1-9 years, with coverage at least at 80%. However, the additional value of higher coverage targeted at children with multiple rounds is unknown.2 × 2 factorial community randomized, double blind, trial.32 communities with prevalence of trachoma ? 20% were randomized to: annual MDA aiming for coverage of children between 80%-90% (usual target) versus aiming for coverag e> 90% (enhanced target); and to: MDA for three years versus a rule of cessation of MDA early if the estimated prevalence of ocular C. trachomatis infection was less than 5%. The primary outcome was the community prevalence of infection with C. trachomatis at 36 months.Over the trial's course, no community met the MDA cessation rule, so all communities had the full 3 rounds of MDA. At 36 months, there was no significant difference in the prevalence of infection, 4.0 versus 5.4 (mean adjusted difference? =?1.4%, 95% CI? = ?-1.0% to 3.8%), nor in the prevalence of trachoma, 6.1 versus 9.0 (mean adjusted difference? =? 2.6%, 95% CI? = ?-0.3% to 5.3%) comparing the usual target to the enhanced target group. There was no difference if analyzed using coverage as a continuous variable.In communities that had pre-treatment prevalence of follicular trachoma of 20% or greater, there is no evidence that MDA can be stopped before 3 annual rounds, even with high coverage. Increasing coverage in children above 90% does not appear to confer additional benefit.

SUBMITTER: West SK

PROVIDER: S-EPMC3757067 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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A randomized trial of two coverage targets for mass treatment with azithromycin for trachoma.

West Sheila K SK Bailey Robin R Munoz Beatriz B Edwards Tansy T Mkocha Harran H Gaydos Charlotte C Lietman Thomas T Porco Travis T Mabey David D Quinn Thomas C TC

PLoS neglected tropical diseases 20130829 8

<h4>Background</h4>The World Health Organization recommends at least 3 annual antibiotic mass drug administrations (MDA) where the prevalence of trachoma is > 10% in children ages 1-9 years, with coverage at least at 80%. However, the additional value of higher coverage targeted at children with multiple rounds is unknown.<h4>Trial design</h4>2 × 2 factorial community randomized, double blind, trial.<h4>Trial methods</h4>32 communities with prevalence of trachoma ≥ 20% were randomized to: annual ...[more]

PMID: 24009792

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Project description:BackgroundMass drug administration with antibiotics predominantly with azithromycin is one of the four arms of the SAFE strategy. The elimination of ocular chlamydial infection is only achieved as long as the azithromycin mass treatments (AMT) are given frequently enough and at a high enough coverage. This study was conducted to assess the coverage of azithromycin mass treatment and its determinants in Awi Zone, Northwestern Ethiopia.MethodsHouse to house survey using a structured questionnaire was done between July 7 to July 25, 2013. Coverage is defined as the proportion of individuals in the eligible population who actually ingested the Azithromycin during the Campaign.ResultsA total of 1267 households were enrolled in the survey in which 5826 eligible members were living in these households. Almost half (54.6%) of the community members who were eligible for all six campaigns had participated in more than three campaigns of azithromycin mass treatment. The overall average self-reported coverage of the azithromycin mass treatment (AMT) in all six campaigns was 62.8% (64% in rural vs. 61.6% urban). On average, each eligible person had taken the drug 3.77 times. The rural residents were significantly more likely to have received treatment during the last round of AMT in 2012 {AOR?=?2.35; 95% CI [1.80-3.06]}. Azithromycin uptake status of female household heads was less than the corresponding male household heads {AOR?=?0.41; 95% CI [0.24-0.72]}. Household heads' awareness about trachoma (AOR?=?2.55; 95% CI [1.19-5.44]) and AMT {AOR?=?7.19; 95% CI [3.27-15.82]} had positive association with acceptability.ConclusionThe overall average AMT coverage was found to be low. There was low coverage of the treatment in the urban community as compared to the rural residents. Misconceptions of household heads about trachoma and azithromycin have negatively affected the coverage. Further work on why female household heads are associated with higher risk of non-participation in AMT is warranted. Strengthening awareness creation and consideration of additional campaigns is essential.

Project description:Mass treatment to trachoma endemic communities is a critical part of the World Health Organization SAFE strategy. However, non-participation may not be at random, affecting coverage surveys and effectiveness if infection is differential. As part of the Partnership for Rapid Elimination of Trachoma (PRET), 32 communities in Tanzania, and 48 in The Gambia had a detailed census taken followed by mass treatment with azithromycin. The target coverage in each community was >80% of children ages <10 years. Community treatment assistants observed treatment and recorded compliance, thus coverage at the community, household, and individual level could be determined. Within each community, we determined the actual proportions of households where all, some, or none of the children were treated. Assuming the coverage in children <10 years of the community was as observed and non-participation was at random, we did 500 simulations to derive expected proportions of households where all, some, or none of the children were treated. Clustering of household treatment was detected comparing greater-than-expected proportions of households where none or all of children were treated, and the intraclass correlation (ICC) was calculated. Tanzanian and Gambian mass treatment coverages for children <10 years of age ranged from 82-100% and 62-99%, respectively. Clustering of households where all children were treated or no children were treated was greater than expected. Compared to model simulations, all Tanzanian communities and 44 of 48 (91.7%) Gambian communities had significantly higher proportions of households where all children were treated. Furthermore, 30 of 32 (93.8%) Tanzanian communities and 34 of 48 (70.8%) Gambian communities had a significantly elevated proportion of households compared to the expected proportion where no children were treated. The ICC for Tanzania was 0.77 (95% CI 0.74-0.81) and for The Gambia was 0.55 (95% CI 0.51-0.59). In programs aiming for high coverage, complete compliance or non-compliance with mass treatment clusters within households. Non-compliance cannot be assumed to be at random.

Project description:BackgroundTrachoma is the leading infectious cause of blindness worldwide. In communities where the district level prevalence of trachomatous inflammation-follicular among children ages 1-9 years is ≥5%, WHO recommends annual mass drug administration (MDA) of antibiotics with the aim of at least 80% coverage. Population-based post-MDA coverage surveys are essential to understand the effectiveness of MDA programs, yet published reports from trachoma programs are rare.MethodsIn the Amhara region of Ethiopia, a population-based MDA coverage survey was conducted 3 weeks following the 2016 MDA to estimate the zonal prevalence of self-reported drug coverage in all 10 administrative zones. Survey households were selected using a multi-stage cluster random sampling design and all individuals in selected households were presented with a drug sample and asked about taking the drug during the campaign. Zonal estimates were weighted and confidence intervals were calculated using survey procedures. Self-reported drug coverage was then compared with regional reported administrative coverage.ResultsRegion-wide, 24,248 individuals were enumerated, of which, 20,942 (86.4%) individuals were present. The regional self-reported antibiotic coverage was 76.8% (95%Confidence Interval (CI):69.3-82.9%) in the population overall and 77.4% (95%CI = 65.7-85.9%) among children ages 1-9 years old. Zonal coverage ranged from 67.8% to 90.2%. Five out of 10 zones achieved a coverage >80%. In all zones, the reported administrative coverage was greater than 90% and was considerably higher than self-reported MDA coverage. Main reasons reported for MDA campaign non-attendance included being physically unable to get to MDA site (22.5%), traveling (20.6%), and not knowing about the campaign (21.0%). MDA refusal was low (2.8%) in this population.ConclusionsAlthough self-reported MDA coverage in Amhara was greater than 80% in some zones, programmatic improvements are warranted throughout Amhara to achieve higher coverage. These results will be used to enhance community mobilization and improve training for MDA distributors and supervisors to improve coverage in future MDAs.

Dataset Information

A randomized trial of two coverage targets for mass treatment with azithromycin for trachoma.

Publications

A randomized trial of two coverage targets for mass treatment with azithromycin for trachoma.

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