PT  - JOURNAL ARTICLE
AU  - Abdou Amza
AU  - Boubacar Kadri
AU  - Beido Nassirou
AU  - Sun Y Cotter
AU  - Nicole E Stoller
AU  - Sheila K West
AU  - Robin L Bailey
AU  - Travis C Porco
AU  - Bruce D Gaynor
AU  - Jeremy D Keenan
AU  - Thomas M Lietman
AU  - Catherine E Oldenburg
TI  - Effectiveness of expanding annual mass azithromycin distribution treatment coverage for trachoma in Niger: a cluster randomised trial
AID  - 10.1136/bjophthalmol-2017-310916
DP  - 2018 May 01
TA  - British Journal of Ophthalmology
PG  - 680--686
VI  - 102
IP  - 5
4099  - http://bjo.bmj.com/content/102/5/680.short
4100  - http://bjo.bmj.com/content/102/5/680.full
SO  - Br J Ophthalmol2018 May 01; 102
AB  - 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.