Effectiveness of expanding annual mass azithromycin distribution treatment coverage for trachoma in Niger: a cluster randomised trial. Issue 5 (11th September 2017)

• Record Type: Journal Article
• Authors: Amza, Abdou; Kadri, Boubacar; Nassirou, Beido; Cotter, Sun Y; Stoller, Nicole E; West, Sheila K; Bailey, Robin L; Porco, Travis C; Gaynor, Bruce D; Keenan, Jeremy D; Lietman, Thomas M; Oldenburg, Catherine E
• Is Part Of: British journal of ophthalmology. Volume 102:Issue 5(2018)
• Page Start: 680
• Page End: 686
• Publication Date: 2017-09-11
• Subjects: Child Health (paediatrics) -- Clinical Trial -- Conjunctiva -- Infection -- Public Health; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjophthalmol-2017-310916
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : Background/aims: The WHO recommends 3–5 years of annual mass azithromycin distribution with at least 80% treatment coverage to districts with active trachoma prevalence over 10% among children. Here, we assess the efficacy of expanding the coverage target to at least 90% for trachoma control in a mesoendemic region of Niger. Methods: Twenty-four communities were randomised to a single day of azithromycin distribution with a coverage target of 80% of the community or up to 4 days of treatment, aiming for greater than 90% coverage. Distributions were annual and individuals above 6 months of age were treated. Children under 5 years of age were monitored for ocular chlamydia infection and active trachoma. Results: At baseline, ocular chlamydia prevalence was 20.5% (95% CI 9.8% to 31.2%) in the standard coverage arm and 21.9% (95% CI 11.3% to 32.5%) in the enhanced coverage arm, which reduced to 4.6% (95% CI 0% to 9.5%, p=0.008) and 7.1% (95% CI 2.7% to 11.4%, p<0.001) at 36 months, respectively. There was no significant difference in 36-month ocular chlamydia prevalence between the two arms (p=0.21). There was no difference in the rate of decline in ocular chlamydia between the two arms in a repeated measures model (p=0.80). Conclusions: For annual mass azithromycin distribution programme to an entire community, there may be no additional benefit of increasing antibiotic coverage above the WHO's 80% target. Trial registration number: NCT00792922, post-results.