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Abstract
Purpose: Trachoma control programs are underway in endemic regions worldwide. They are based on the SAFE strategy (Surgery for trichiasis, Antibiotic distribution, Facial cleanliness, and Environmental improvement). Although much is known about the effect of community-wide treatment with antibiotics on the prevalence of Chlamydia trachomatis, the impact of the SAFE strategy on severe ocular disease sequelae (the main focus of the Global Elimination of blinding Trachoma by 2020 program) remains largely unknown.
Methods: We use a mathematical model to explore the impact of each of the components of the SAFE strategy, individually and together, on disease sequelae, arising from repeat infection and subsequent conjunctival scarring. We ask whether two elimination goals, to reduce the prevalence of trachomatous trichiasis to 1 per 1000 persons, and the incidence of corneal opacity to 1 per 10,000 persons per annum, are achievable, and which combinations of interventions have the greatest impact on these indicators.
Results: In high prevalence communities (here, >20% infection of children aged 1–9 years), a combination of efforts is needed to bring down sustainably the prevalence and incidence of ocular disease sequelae.
Conclusion: The mass delivery of antibiotics is highly beneficial for the clearance of infection, inflammation and prevention of subsequent scarring, but needs to be supplemented with sustained reductions in transmission and surgery to consider realistically the elimination of blindness by the year 2020.
Acknowledgments
At the International Trachoma Initiative, we thank the former staff members, Jacob Kumaresan, Felicity Turner, Ibrahim Jabr, and Danny Haddad, and the current Research Director Huub Gelderblom, for their very valuable support.
The study did not require IRB approval due to its anonymous nature and dependence on previously published data.
Declaration of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
The International Trachoma Initiative (ITI) financed the initial development of the trachoma models presented here. NCG acknowledges the Royal Society for a University Research Fellowship, and the Medical Research Council, UK, for Centre funding support. MJB thanks the Wellcome Trust for a fellowship [Grant No: 098481/Z/12/Z]. M-GB thanks the Wellcome Trust and the Royal Society for project grants in neglected tropical diseases. The field studies used to develop the model were supported by a Wellcome Trust-Burroughs Wellcome Fund grant to DCM and RLB [Grant No. 052134]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Supplemental Material Supplemental data for this article can be accessed on the publisher’s website.