Conclusions & Recommendations

TEC notes with enthusiasm the ongoing research on the use of azithromycin for child survival and looks forward to future discussions and presentations of data.

TEC was excited to see the co-administration and pharmacokinetics and pharmacodynamics (PK/PD) trial results demonstrating the safety of delivering azithromycin with ivermectin, albendazole, or diethylcarbamazine. TEC recommends to ITI management to support the WHO Guidelines Review Committee process.

TEC appreciates the work that has already been done to develop electronic data systems to collect and manage data related to mass drug administration and looks forward to following future developments to optimize the quality of data on drug coverage to improve and refine programs.

TEC appreciated the inclusion of national program managers at TEC 28, whose presence provided additional richness and insights into discussions.

The TEC suggested several options for national trachoma programs to consider as they decide how best to manage their reduced allocations (in no particular order):
- Consider prioritizing high prevalence districts (TF1-9 ≥30%)
- Consider prioritizing districts with persistent or recrudescent trachoma
- Consider early trachoma impact surveys for any district currently in the last round of MDA (i.e., 3/3; 5/5; 7/7)
- Consider delaying or skipping treatment in districts with TF1-9 5-9%

TEC also suggests national trachoma programs consider collecting data on alternative indicators (e.g., infection and/or serology) during impact surveys to guide prioritization and decision making.

The TEC asked that ITI expeditiously convene teleconferences to communicate these decisions and options with national programs and implementing partners, in collaboration with TEC and WHO.

After weighing and discussing the pros and cons of several options to distribute the reduced Zithromax supply to national programs in a way that is fair, recognizes the need for flexibility in decisions by national trachoma programs, and maintains progress towards elimination of blinding trachoma, the TEC recommends that ITI:
- reduce Zithromax shipments to 80% of the amount requested by all countries (but not yet shipped), effective immediately
- prioritize requests initially scheduled for shipment in 2022, but do not ship a second dose to those districts in 2023 unless drug becomes available in late 2023
- ship 95% of all operational research allocations and for trichiasis surgeries

TEC noted with concern the current global shortage of Zithromax and appreciated Pfizer’s engagement and transparency in describing the associated challenges at TEC 28. The TEC encourages frequent ongoing conversations between Pfizer and ITI regarding the shortage and evolving plans to address it, which will facilitate ITI in providing clear, transparent guidance to national trachoma programs and implementing partners.

BMGF and USAID would like to provide OR funding to evaluate the implementation of modified treatment strategies, and share learnings to apply in additional areas. TEC acknowledged the potential contribution of funding for operational research on modified strategies in persistent/recrudescent areas, and noted with concern the need for the funding for research to be coordinated with regular programmatic funding for surveys, taking into account the need for both cost efficiencies and timing. TEC recommends that ITI schedule a meeting with BMGF, USAID, and the NTD Support Center to better understand plans and get clarity on the TEC’s proposed role in reviewing proposals for operational research on modified strategies.

In CIV, infection and serological data were available that demonstrated a lack of significant transmission, a meeting was held among the National NTD Program, WHO, CDC and partners and it was decided that MDA could be stopped and a TSS would not be required in those evaluation units. TEC recognizes the opportunity to fast track progress towards dossier in those evaluation units in Côte d’Ivoire, and possibly an opportunity for other countries if infection and serologic criteria for stopping MDA can be established. TEC recommends that ITI offer to WHO to host an informal consultation on the collection and use of serology and infection data in programmatic decision making.

TEC notes the urgent need for funding to conduct prevalence surveys and scale up treatments in key areas (e.g., CAR, DRC, etc.) and is concerned that inaction jeopardizes the ability to reach global trachoma elimination.

TEC recommends that ITI work with the Republic of South Sudan Ministry of Health and implementing partners to improve population estimates in Unity state.