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

• Published in: PloS one 2017-06, Vol.12 (6), p.e0178595
• Main Authors: West, Sheila K, Munoz, Beatriz, Mkocha, Harran, Dize, Laura, Gaydos, Charlotte A, Swenor, Bonnie, Ervin, Ann-Margret, Quinn, Thomas C
• Format: Article
• Language: English
• Subjects: Age; Anti-Bacterial Agents - therapeutic use; Arrivals; Azithromycin - therapeutic use; Bacteria; Biology and Life Sciences; Causes of; Child; Child, Preschool; Children; Chlamydia; Chlamydia trachomatis; Cluster Analysis; Communities; Community; Demographic aspects; Diseases; Female; Health aspects; Humans; Infant; Infections; Intervention; Laboratories; Male; Medicine; Medicine and Health Sciences; Population Surveillance; Research and Analysis Methods; Sexually transmitted diseases; STD; Studies; Surveillance; Trachoma; Trachoma - drug therapy; Trachoma - epidemiology; Travel; Travelers
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0178595

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%. 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). 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). 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.