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BLINDING TRACHOMA: PREVENTION WITH THE SAFE STRATEGY

Trachoma, the second leading cause of blindness worldwide, differentially affects the poorest communities, which may have the least access to resources. With the establishment of the Global Elimination of Blinding Trachoma by 2020 (GET 2020) goal, the World Health Organization has set an ambitious target for country programs. The currently recommended surgery for trichiasis/entropion, antibiotics for active disease, facial cleanliness, and environmental change to reduce transmission (SAFE) strategy targets all key elements believed to be necessary for a short- and long-term intervention program. This report reviews the need for a multi-faceted strategy, and the evidence supporting the elements of SAFE. Concerns about the implementation are discussed. Additional research is suggested that will enhance the implementation of the SAFE strategy. In the current climate of significant political and social momentum for trachoma control, the SAFE strategy is a safe bet to accomplish the elimination of blinding trachoma.

Received July 30, 2003. Accepted for publication September 17, 2003.

Acknowledgments: I am grateful for the support of the International Trachoma Initiative, and the Edna McConnell Clark Foundation, which has provided financial support for most of the research in trachoma. The paper is dedicated to Dr. Joseph Cook, whose leadership in recognizing the value of research as well as programs is the reason considerable progress in trachoma control has been made. Without that vision, most of us would never have been able to work in trachoma.

Financial support: This work was supported in part by a grant from the National Eye Institute (U01EY01387).

Author’s address: Sheila K. West, Wilmer Eye Institute, Room 129, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287, Telephone: 410-955-2606, Fax: 410-955-0096, E-mail: shwest{at}jhmi.edu.

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