A Cluster-Randomized Trial to Assess the Efficacy of Targeting Trachoma Treatment to Children

Area of Science:

• Ophthalmology
• Infectious Diseases
• Public Health

Background:

• Trachoma is a leading cause of preventable blindness globally.
• The World Health Organization (WHO) recommends annual mass antibiotic treatment for trachoma control.
• Children are disproportionately affected by trachoma, exhibiting higher infection rates and longer durations.

Purpose of the Study:

• To compare the efficacy of biannual mass treatment of children with annual mass treatment of entire communities for trachoma control.
• To evaluate the impact of different treatment strategies on ocular chlamydial infection prevalence in both children and adults.

Main Methods:

• A randomized controlled trial was conducted in 48 communities in Matameye, Niger.
• Communities were assigned to either annual oral azithromycin for all residents or biannual azithromycin for children aged 0-12 years.
• Ocular chlamydial infection was monitored in children and adults using polymerase chain reaction (PCR).

Main Results:

• Childhood infection prevalence decreased significantly in both arms: from 21.2% to 5.8% in the annual treatment arm and from 20.2% to 3.8% in the biannual treatment arm.
• Adult infection prevalence also reduced significantly in both arms, from 1.7% to 0.3% (annual) and 1.2% to 0.0% (biannual).
• Biannual treatment of children was found to be non-inferior to annual community-wide treatment for both children and adults.

Conclusions:

• Targeted biannual antibiotic distribution to children effectively reduces ocular chlamydial infection in trachoma-endemic communities.
• This strategy provides herd protection, impacting infection rates in untreated adults.
• Biannual treatment of children offers a comparable alternative to annual community-wide treatment, with potential advantages in antibiotic stewardship and logistics.