RT Journal Article SR Electronic T1 Effectiveness of expanding annual mass azithromycin distribution treatment coverage for trachoma in Niger: a cluster randomised trial JF British Journal of Ophthalmology JO Br J Ophthalmol FD BMJ Publishing Group Ltd. SP 680 OP 686 DO 10.1136/bjophthalmol-2017-310916 VO 102 IS 5 A1 Amza, Abdou A1 Kadri, Boubacar A1 Nassirou, Beido A1 Cotter, Sun Y A1 Stoller, Nicole E A1 West, Sheila K A1 Bailey, Robin L A1 Porco, Travis C A1 Gaynor, Bruce D A1 Keenan, Jeremy D A1 Lietman, Thomas M A1 Oldenburg, Catherine E YR 2018 UL http://bjo.bmj.com/content/102/5/680.abstract 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.