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 journalArticlepeer-review

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

Keywords

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

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience

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