Treating village newcomers and travelers for trachoma: Results from ASANTE cluster randomized trial

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Abstract

Trial design Trachoma is targeted for global elimination. Infection rates with Chlamydia trachomatis are higher in new arrivals to a community and in travelers who leave for extended periods, suggesting they are sources of re-infection. This community-randomized, clinical trial was designed to determine if a surveillance program that targeted newcomers and travelers, identified weekly, would result in more communities achieving levels of infection of 1%. Methods 52 communities were randomly allocated 1:1 to the control (annual MDA alone if warranted) or intervention arm (annual MDA if warranted, plus a surveillance program to identify and treat newcomers and travelers). In each community, surveys were completed every six months on a random sample of 100 children ages 1±9 years for trachoma and infection. The primary outcome was the proportion of communities in the intervention arm, compared to the control arm, which had a prevalence of infection at 1% by 24 months. Registered: clinicaltrials. gov(NCT01767506). Results Intervention communities experienced an average of 110 surveillance events per month. At 24 months, 7 (27%) of 26 intervention communities achieved a prevalence of infection 1% compared to 4 (15%) of the 26 control communities (odds ratio = 2-6, 95%CI = 0-56±11-9). At 24 months, the average infection prevalence in the intervention communities was 4-8, compared to 6-9 in the control communities (p = -06). Conclusion Despite surveillance programs for community newcomers and travelers, the proportion of intervention communities with a level of infection 1% was lower than expected and not significantly different from control communities.

Original languageEnglish (US)
Article numbere0178595
JournalPLoS One
Volume12
Issue number6
DOIs
StatePublished - Jun 1 2017

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Trachoma
villages
infection
Infection
monitoring
community programs
Chlamydia trachomatis
randomized clinical trials
odds ratio

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

@article{22e47378e75c4277b524998d22249c69,
title = "Treating village newcomers and travelers for trachoma: Results from ASANTE cluster randomized trial",
abstract = "Trial design Trachoma is targeted for global elimination. Infection rates with Chlamydia trachomatis are higher in new arrivals to a community and in travelers who leave for extended periods, suggesting they are sources of re-infection. This community-randomized, clinical trial was designed to determine if a surveillance program that targeted newcomers and travelers, identified weekly, would result in more communities achieving levels of infection of 1{\%}. Methods 52 communities were randomly allocated 1:1 to the control (annual MDA alone if warranted) or intervention arm (annual MDA if warranted, plus a surveillance program to identify and treat newcomers and travelers). In each community, surveys were completed every six months on a random sample of 100 children ages 1±9 years for trachoma and infection. The primary outcome was the proportion of communities in the intervention arm, compared to the control arm, which had a prevalence of infection at 1{\%} by 24 months. Registered: clinicaltrials. gov(NCT01767506). Results Intervention communities experienced an average of 110 surveillance events per month. At 24 months, 7 (27{\%}) of 26 intervention communities achieved a prevalence of infection 1{\%} compared to 4 (15{\%}) of the 26 control communities (odds ratio = 2-6, 95{\%}CI = 0-56±11-9). At 24 months, the average infection prevalence in the intervention communities was 4-8, compared to 6-9 in the control communities (p = -06). Conclusion Despite surveillance programs for community newcomers and travelers, the proportion of intervention communities with a level of infection 1{\%} was lower than expected and not significantly different from control communities.",
author = "West, {Sheila K} and Beatriz Munoz and Harran Mkocha and Laura Dize and Gaydos, {Charlotte A} and Bonnielin Swenor and Ervin, {Ann Margret} and Quinn, {Thomas C}",
year = "2017",
month = "6",
day = "1",
doi = "10.1371/journal.pone.0178595",
language = "English (US)",
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T1 - Treating village newcomers and travelers for trachoma

T2 - Results from ASANTE cluster randomized trial

AU - West, Sheila K

AU - Munoz, Beatriz

AU - Mkocha, Harran

AU - Dize, Laura

AU - Gaydos, Charlotte A

AU - Swenor, Bonnielin

AU - Ervin, Ann Margret

AU - Quinn, Thomas C

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Trial design Trachoma is targeted for global elimination. Infection rates with Chlamydia trachomatis are higher in new arrivals to a community and in travelers who leave for extended periods, suggesting they are sources of re-infection. This community-randomized, clinical trial was designed to determine if a surveillance program that targeted newcomers and travelers, identified weekly, would result in more communities achieving levels of infection of 1%. Methods 52 communities were randomly allocated 1:1 to the control (annual MDA alone if warranted) or intervention arm (annual MDA if warranted, plus a surveillance program to identify and treat newcomers and travelers). In each community, surveys were completed every six months on a random sample of 100 children ages 1±9 years for trachoma and infection. The primary outcome was the proportion of communities in the intervention arm, compared to the control arm, which had a prevalence of infection at 1% by 24 months. Registered: clinicaltrials. gov(NCT01767506). Results Intervention communities experienced an average of 110 surveillance events per month. At 24 months, 7 (27%) of 26 intervention communities achieved a prevalence of infection 1% compared to 4 (15%) of the 26 control communities (odds ratio = 2-6, 95%CI = 0-56±11-9). At 24 months, the average infection prevalence in the intervention communities was 4-8, compared to 6-9 in the control communities (p = -06). Conclusion Despite surveillance programs for community newcomers and travelers, the proportion of intervention communities with a level of infection 1% was lower than expected and not significantly different from control communities.

AB - Trial design Trachoma is targeted for global elimination. Infection rates with Chlamydia trachomatis are higher in new arrivals to a community and in travelers who leave for extended periods, suggesting they are sources of re-infection. This community-randomized, clinical trial was designed to determine if a surveillance program that targeted newcomers and travelers, identified weekly, would result in more communities achieving levels of infection of 1%. Methods 52 communities were randomly allocated 1:1 to the control (annual MDA alone if warranted) or intervention arm (annual MDA if warranted, plus a surveillance program to identify and treat newcomers and travelers). In each community, surveys were completed every six months on a random sample of 100 children ages 1±9 years for trachoma and infection. The primary outcome was the proportion of communities in the intervention arm, compared to the control arm, which had a prevalence of infection at 1% by 24 months. Registered: clinicaltrials. gov(NCT01767506). Results Intervention communities experienced an average of 110 surveillance events per month. At 24 months, 7 (27%) of 26 intervention communities achieved a prevalence of infection 1% compared to 4 (15%) of the 26 control communities (odds ratio = 2-6, 95%CI = 0-56±11-9). At 24 months, the average infection prevalence in the intervention communities was 4-8, compared to 6-9 in the control communities (p = -06). Conclusion Despite surveillance programs for community newcomers and travelers, the proportion of intervention communities with a level of infection 1% was lower than expected and not significantly different from control communities.

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