Conclusions & Recommendations

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.

TEC recommends that ITI work with the Ethiopia Federal Ministry of Health, Regional Health Bureaus and implementing partners in SNNP, Sidama, and SWEP to review woreda populations following district splits.

Recognizing the progress made under very challenging circumstances in the Central African Republic, TEC notes with concern the lack of distribution reports from 2020 and 2021 and encourages ITI’s program team to follow up with the Ministry of Health prior to future Zithromax® shipments. TEC also noted the urgent need for support for additional population-based prevalence surveys in areas with stale or no data.

TEC noted the situation in Mutasa district in Zimbabwe where a survey found a level of TF unprecedented in Zimbabwe and very rare in southern Africa more generally. TEC noted further that Mutasa is adjacent to a district that has not so far been mapped. While noting that no drug request for Mutasa has been included for 2023, TEC was concerned to clarify the situation and suggests that (i) the programme and its partners consider an enhanced investigation of Mutasa, for example, with tests for Ct infection and pGP serology, and (ii) that further baseline mapping be considered both in districts adjacent to Mutasa and in districts adjacent to those in which actionable TF prevalences had been recorded.

TEC recommends to ITI to send an additional letter to all partners addressing the temporary Zithromax® delays, including:
- this is a temporary mismatch of supply and demand, both of which are uncertain,
- ITI’s expectation is that supply will catch back up to demand by the end of 2022,
- all current drug needs will be met over the next ~6 months,
- this is a temporary shipment timing issue
- outlining the factors and principles (e.g., efficiency, equity) that ITI normally uses to determine timing/order of shipments as drug becomes available, reinforcing that the decision-making process has not changed in this situation

TEC recommends that ITI-Ethiopia offer to host a pre-TEC NTTF meeting involving the TEC liaisons to ensure partners are aligned and aware of the following year’s work plans and other issues.

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