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Effectiveness of expanding annual mass azithromycin distribution treatment coverage for trachoma in Niger: a cluster randomised trial
  1. Abdou Amza1,
  2. Boubacar Kadri1,
  3. Beido Nassirou1,
  4. Sun Y Cotter2,
  5. Nicole E Stoller2,
  6. Sheila K West3,
  7. Robin L Bailey4,
  8. Travis C Porco2,5,6,
  9. Bruce D Gaynor2,5,
  10. Jeremy D Keenan2,5,6,
  11. Thomas M Lietman2,5,6,
  12. Catherine E Oldenburg2,5,6
  1. 1Programme FSS/Université Abdou Moumouni de Niamey, Programme National de Santé Oculaire, Niamey, Niger
  2. 2F.I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA
  3. 3Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
  4. 4Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
  5. 5Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
  6. 6Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Catherine E Oldenburg, 513 Parnassus Ave, San Francisco, CA 94143, USA; catherine.oldenburg{at}ucsf.edu

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.

  • Child Health (paediatrics)
  • Clinical Trial
  • Conjunctiva
  • Infection
  • Public Health

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Footnotes

  • Contributors AA: study design, study implementation, data collection, results interpretation, drafting and approval. BK, BN, SC, NS: study design, study implementation, data collection, revision and approval. SW, RB, BDG: obtaining funding, study design, study implementation, data collection, revision and approval. TCP, JDK: study design, study implementation, data collection, data analysis, data interpretation, revision and approval. TML, obtaining funding, study design, study implementation, data collection, data analysis, data interpretation, drafting, revision and approval. CEO, study design, study implementation, data collection, data analysis, data interpretation, drafting, revision and approval.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Committee on Human Research, University of California, San Francisco; Comité d'Ethique du Niger.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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