Document Detail


Can we stop mass drug administration prior to 3 annual rounds in communities with low prevalence of trachoma?: PRET Ziada trial results.
MedLine Citation:
PMID:  23392481     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
IMPORTANCE: The World Health Organization recommends at least 3 annual mass drug administrations (MDAs) of azithromycin in places where the prevalence of follicular trachoma (FT) is greater than 10%. However, stopping MDA prior to 3 rounds, if monitoring indicates an absence of infection with Chlamydia trachomatis even if FT persists, may be more cost-effective.
OBJECTIVE: To determine the prevalence of infection in communities randomized to 3 rounds of annual MDAs with azithromycin compared with communities randomized to a stopping rule, where MDA could cease if the infection rate was low. DESIGN A 1:1 community randomized trial comparing usual care with a cessation rule. The Partnership for the Rapid Elimination of Trachoma-Ziada Trial was conducted from February 1, 2010, through September 1, 2011.
SETTING: Sixteen communities in Tanzania with trachoma prevalence rates between 10% and 20%.
PARTICIPANTS: A total of 100 children aged 5 years or younger randomly drawn from each community. Children had to reside in an eligible community, have no ocular condition that prevented trachoma grading or ocular specimen collection, and have a guardian who could provide consent for participation.
INTERVENTIONS: Cessation of MDA with azithromycin if the community had no infection in their sample at 6 months or 18 months.
MAIN OUTCOME MEASURE: The prevalence of C trachomatis at 18 months.
RESULTS: None of the intervention communities met criteria to stop MDA based on the 6-month or 18-month survey; all, as well as the usual care communities, were scheduled for a third MDA round. There was no difference in infection (2.9% vs 4.7%; P = .25) between the usual care and cessation rule communities at 18 months.
CONCLUSIONS AND RELEVANCE: In this setting, communities with low (10%-20%) initial prevalence of active trachoma did not have MDA stopped before 3 annual rounds on the basis of monitoring for infection. Infection with C trachomatis in communities with average trachoma rates at 12% to 13% cannot be eliminated before 3 rounds of MDA with azithromycin.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00792922.
Authors:
Jithin Yohannan; Beatriz Munoz; Harran Mkocha; Charlotte A Gaydos; Robin Bailey; Thomas A Lietman; Thomas Quinn; Sheila K West
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA ophthalmology     Volume:  131     ISSN:  2168-6173     ISO Abbreviation:  JAMA Ophthalmol     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-04-12     Completed Date:  2013-06-05     Revised Date:  2013-10-17    
Medline Journal Info:
Nlm Unique ID:  101589539     Medline TA:  JAMA Ophthalmol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  431-6     Citation Subset:  AIM; IM    
Affiliation:
Dana Center for Preventive Ophthalmology, USA.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00792922
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MeSH Terms
Descriptor/Qualifier:
Anti-Bacterial Agents / administration & dosage*
Azithromycin / administration & dosage*
Child
Child, Preschool
Chlamydia Infections / drug therapy,  epidemiology*,  microbiology
Chlamydia trachomatis / isolation & purification
Community Health Services
Community-Acquired Infections / drug therapy,  epidemiology*,  microbiology
Female
Humans
Infant
Male
Mass Screening
Practice Guidelines as Topic
Prevalence
Tanzania / epidemiology
Trachoma / drug therapy,  epidemiology*,  microbiology
Treatment Outcome
Withholding Treatment*
World Health Organization
Grant Support
ID/Acronym/Agency:
ZIA AI000358-30/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 83905-01-5/Azithromycin
Comments/Corrections

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