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 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.

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

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 appreciates the continued efforts in infection and serology and expressed support for WHO to develop standardized protocols and define thresholds for trachoma program decision-making. As additional data become available, TEC requests future presentations from national programs and partners on this topic.

As information from the ICTC Inventory becomes available, TEC recommends that ITI work with host endemic countries to ensure that all populations have access to trachoma treatments where needed.

TEC reiterated its concern that not all populations in need of Zithromax for trachoma have access to it, and looks forward to further information from the ICTC Inventory on at-risk populations for whom current survey approaches might pose a barrier to access.

In order to leave no one behind, national trachoma programs are encouraged to seek these populations and continue using the decision algorithm to support reaching must-reach populations in their specific contexts.

TEC noted with appreciation that Tropical Data’s and partners’ survey methodologies and adaptations have provided adequate data for decisions on allocating Zithromax® and noted the need for continued flexibility in specific contexts. TEC encourages the continued development of simplified approaches to enhance access.

The TEC appreciated the analysis and presentation of examples on how the algorithm developed by the TEC Refugee/IDP Request Guidelines Subcommittee has been used for allocating Zithromax® to refugees, displaced persons, and migratory populations. Application of this algorithm in practice aspires to TEC’s values of equity and inclusion.