OBJECTIVES:One criterion for trachoma elimination is a prevalence of trachomatous inflammation-follicular in children aged 1-9 years (TF1-9) < 5% in all formerly endemic implementation units (IUs). After years of antibiotic mass drug administration, many IUs have trachoma impact survey (TIS) or trachoma surveillance survey (TSS) results TF1-9 ≥ 5%. METHODS:We analyzed global data to explore potential correlates associated with TF1-9 ≥ 5% at the first TIS (TIS1), the second or higher TIS (TIS2+), and TSS. Univariable and multivariable logistic regression models were fitted. RESULTS:A total of 1,966 IUs in 33 countries were included. From multivariable models, at TIS1, higher baseline TF1-9 category (odds ratio [OR]: 10.22, 95% confidence interval [CI] 4.66-22.43) was significantly associated with TF1-9 ≥ 5%. At TIS2+, higher immediate previous survey TF1-9 (OR: 3.23, 95% CI 1.30-8.05) and lower access to a nearby water source (OR: 3.05, 95% CI 1.10-8.47) were significantly associated with TF1-9 ≥ 5%. At TSS, higher previous TIS TF1-9 (OR: 4.08, 95% CI 1.76-9.46) and lower access to sanitation (OR: 2.17, 95% CI 1.02-4.63) were significantly associated with TF1-9 ≥ 5%. CONCLUSION:Understanding TIS/TSS TF1-9 ≥ 5% correlates can ensure programs target enhanced interventions, monitoring, and further research appropriately.

Assessing the feasibility of 2030 as a target date for global elimination of trachoma, and identification of districts that may require enhanced treatment to meet World Health Organization (WHO) elimination criteria by this date are key challenges in operational planning for trachoma programmes. Here we address these challenges by prospectively evaluating forecasting models of trachomatous inflammation-follicular (TF) prevalence, leveraging ensemble-based approaches. Seven candidate probabilistic models were developed to forecast district-wise TF prevalence in 11 760 districts, trained using district-level data on the population prevalence of TF in children aged 1-9 years from 2004 to 2022. Geographical location, history of mass drug administration treatment, and previously measured prevalence data were included in these models as key predictors. The best-performing models were included in an ensemble, using weights derived from their relative likelihood scores. To incorporate the inherent stochasticity of disease transmission and challenges of population-level surveillance, we forecasted probability distributions for the TF prevalence in each geographic district, rather than predicting a single value. Based on our probabilistic forecasts, 1.46% (95% confidence interval [CI]: 1.43-1.48%) of all districts in trachoma-endemic countries, equivalent to 172 districts, will exceed the 5% TF control threshold in 2030 with the current interventions. Global elimination of trachoma as a public health problem by 2030 may require enhanced intervention and/or surveillance of high-risk districts.

Purpose Population-based prevalence surveys are essential for decision-making on interventions to achieve trachoma elimination as a public health problem. This paper outlines the methodologies of Tropical Data, which supports work to undertake those surveys.Methods Tropical Data is a consortium of partners that supports health ministries worldwide to conduct globally standardised prevalence surveys that conform to World Health Organization recommendations. Founding principles are health ministry ownership, partnership and collaboration, and quality assurance and quality control at every step of the survey process. Support covers survey planning, survey design, training, electronic data collection and fieldwork, and data management, analysis and dissemination. Methods are adapted to meet local context and needs. Customisations, operational research and integration of other diseases into routine trachoma surveys have also been supported.Results Between 29th February 2016 and 24th April 2023, 3373 trachoma surveys across 50 countries have been supported, resulting in 10,818,502 people being examined for trachoma.Conclusion This health ministry-led, standardised approach, with support from the start to the end of the survey process, has helped all trachoma elimination stakeholders to know where interventions are needed, where interventions can be stopped, and when elimination as a public health problem has been achieved. Flexibility to meet specific country contexts, adaptation to changes in global guidance and adjustments in response to user feedback have facilitated innovation in evidence-based methodologies, and supported health ministries to strive for global disease control targets.

Background Global elimination of trachoma as a public health problem was targeted for 2020. We reviewed progress towards the elimination of active trachoma by country and geographical group. Methods In this retrospective analysis of national survey and implementation data, all countries ever known to be endemic for trachoma that had either implemented at least one trachoma impact survey shown in the publicly available Trachoma Atlas, or are in Africa were invited to participate in this study. Scale-up was described according to the number of known endemic implementation units and mass drug administration implementation over time. The prevalence of active trachoma-follicular among children aged 1-9 years (TF 1-9) from baseline, impact, and surveillance surveys was categorised and used to show programme progress towards reaching the elimination threshold (TF 1-9 <5%) using dot maps, spaghetti plots, and boxplots. Findings We included data until Nov 10, 2021, for 38 countries, representing 2097 ever-endemic implementation units. Of these, 1923 (91.7%) have had mass drug administration. Of 1731 implementation units with a trachoma impact survey, the prevalence of TF 1-9 had reduced by at least 50% in 1465 (84.6%) implementation units and 1182 (56.4%) of 2097 ever-endemic implementation units had reached the elimination threshold. 2 years after reaching a TF 1-9 prevalence below 5%, most implementation units sustained this target; however, 58 (56.3%) of 103 implementation units in Ethiopia showed recrudescence. Interpretation Global elimination of trachoma as a public health problem by 2020 was not possible, but this finding masks the great progress achieved. Implementation units in high baseline categories and recrudescent TF 1-9 might prolong the attainment of elimination of active trachoma. Elimination is delayed but, with an understanding of the patterns and timelines to reaching elimination targets and a commitment toward meeting future targets, global elimination can still be achieved by 2030. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.

Background: Global elimination of trachoma as a public health problem was targeted for 2020. This binary target was reached by 10/53 endemic countries by 2020. We reviewed progress toward elimination by country and geographic group.Methods: The analysis includes 38 countries. Scale-up was described based on the number of known endemic implementation units (IUs) and mass drug administration (MDA) implementation over time. Trachoma prevalence from baseline, impact and surveillance surveys was categorized and used to show program progress using dot density maps, spaghetti plots and boxplots. The number of MDA rounds were analyzed to summarize implementation timelines.Findings: The trachoma program is scaling-down and prevalence is declining: of 2,085 endemic IUs, 1,939 (93.0%) have had MDA; active trachoma—follicular (TF1-9) has declined by at least 50% in 1,253 (60.0%); 1,022 (49.0%) reached the elimination threshold (TF1-9<5%). The median number of MDA rounds to elimination varies by country, with higher baseline categories taking longer to reach elimination. Two years after reaching elimination the majority of IUs sustained TF1-9<5%, however, nearly half of those in Ethiopia demonstrated recrudescence. IUs in high baseline categories may require considerably more rounds of MDA.Interpretation: Global elimination of trachoma as a public health problem by 2020 was not possible, but this masks the great progress achieved. Global elimination is delayed, but with an understanding of the patterns and timelines to reaching elimination targets and a commitment toward achieving future targets, elimination will not be denied.Funding Information: No specific funding was used for this analysis.Declaration of Interests: The authors declare no conflicts of interest.Ethics Approval Statement: Ethics Committee Approval was not required because this analysis is not considered human subjects research.