Evaluation of a Single Dose of Azithromycin for Trachoma in Low-Prevalence Communities

Nana Wilson, Brook Goodhew, Harran Mkocha, Kahaliah Joseph, Claudiu Bandea, Carolyn Black, Joseph Igietseme, Beatriz Munoz, Sheila K West, Patrick Lammie, Mabula Kasubi, Diana L. Martin

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Abstract

Purpose: Trachoma, caused by repeated ocular infection with Chlamydia trachomatis, is the leading infectious cause of blindness worldwide and is targeted for elimination as a public health problem. We sought to determine whether a one-time azithromycin mass treatment would reduce trachomatous inflammation–follicular (TF) levels below the elimination threshold of 5% in communities with disease prevalence between 5 and 9.9%. Methods: The study was conducted in 96 sub-village units (balozis) in the Kongwa district of Tanzania which were predicted from prior prevalence surveys to have TF between 5 and 9.9%. Balozis were randomly assigned to the intervention and control arms. The intervention arm received a single mass drug administration of azithromycin. At baseline and 12-month follow-up, ocular exams for trachoma, ocular swabs for detection of chlamydial DNA, and finger prick blood for analysis of anti-chlamydial antibody were taken. Results: Comparison of baseline and 12-month follow-up showed no significant difference in the overall TF1-9 prevalence by balozi between control and treatment arms. In the treatment arm there was a significant reduction of ocular infection 12 months after treatment (p = 0.004) but no change in the control arm. No change in Pgp3-specific antibody responses were observed after treatment in the control or treatment arms. Anti-CT694 responses increased in both study arms (p = 0.009 for control arm and p = 0.04 for treatment arm). Conclusion: These data suggest that a single round of MDA may not be sufficient to decrease TF levels below 5% when TF1-9 is between 5 and 9.9% at baseline.

Original languageEnglish (US)
JournalOphthalmic Epidemiology
DOIs
StateAccepted/In press - Jan 1 2018

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Keywords

  • Antibody
  • chlamydia
  • mass drug administration
  • trachoma
  • trachomatis

ASJC Scopus subject areas

  • Epidemiology
  • Ophthalmology

Cite this

Wilson, N., Goodhew, B., Mkocha, H., Joseph, K., Bandea, C., Black, C., Igietseme, J., Munoz, B., West, S. K., Lammie, P., Kasubi, M., & Martin, D. L. (Accepted/In press). Evaluation of a Single Dose of Azithromycin for Trachoma in Low-Prevalence Communities. Ophthalmic Epidemiology. https://doi.org/10.1080/09286586.2017.1293693