Effectiveness of expanding annual mass azithromycin distribution treatment coverage for trachoma in Niger: A cluster randomised trial

Abdou Amza, Boubacar Kadri, Beido Nassirou, Sun Y. Cotter, Nicole E. Stoller, Sheila K West, Robin L. Bailey, Travis C. Porco, Bruce D. Gaynor, Jeremy D. Keenan, Thomas M. Lietman, Catherine E. Oldenburg

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)680-686
Number of pages7
JournalBritish Journal of Ophthalmology
Volume102
Issue number5
DOIs
StatePublished - May 1 2018

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Trachoma
Niger
Azithromycin
Chlamydia
Eye Infections
Chlamydia Infections
Therapeutics
Anti-Bacterial Agents

Keywords

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

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience

Cite this

Effectiveness of expanding annual mass azithromycin distribution treatment coverage for trachoma in Niger : A cluster randomised trial. / 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.

In: British Journal of Ophthalmology, Vol. 102, No. 5, 01.05.2018, p. 680-686.

Research output: Contribution to journalArticle

Amza, A, Kadri, B, Nassirou, B, Cotter, SY, Stoller, NE, West, SK, Bailey, RL, Porco, TC, Gaynor, BD, Keenan, JD, Lietman, TM & Oldenburg, CE 2018, 'Effectiveness of expanding annual mass azithromycin distribution treatment coverage for trachoma in Niger: A cluster randomised trial', British Journal of Ophthalmology, vol. 102, no. 5, pp. 680-686. https://doi.org/10.1136/bjophthalmol-2017-310916
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. / Effectiveness of expanding annual mass azithromycin distribution treatment coverage for trachoma in Niger : A cluster randomised trial. In: British Journal of Ophthalmology. 2018 ; Vol. 102, No. 5. pp. 680-686.
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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.",
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AU - Amza, Abdou

AU - Kadri, Boubacar

AU - Nassirou, Beido

AU - Cotter, Sun Y.

AU - Stoller, Nicole E.

AU - West, Sheila K

AU - Bailey, Robin L.

AU - Porco, Travis C.

AU - Gaynor, Bruce D.

AU - Keenan, Jeremy D.

AU - Lietman, Thomas M.

AU - Oldenburg, Catherine E.

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N2 - 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.

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.

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