Comparison of Mass Azithromycin Coverage Targets of Children in Niger: A Cluster-Randomized Trachoma Trial

Catherine E. Oldenburg F.I. Proctor Foundation, University of California San Francisco, San Francisco, California;
Department of Ophthalmology, University of California San Francisco, San Francisco, California;

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Abdou Amza Programme FSS/Université Abdou Moumouni de Niamey, Programme National de Santé Oculaire, Niamey, Niger;

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Boubacar Kadri Programme FSS/Université Abdou Moumouni de Niamey, Programme National de Santé Oculaire, Niamey, Niger;

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Beido Nassirou Programme FSS/Université Abdou Moumouni de Niamey, Programme National de Santé Oculaire, Niamey, Niger;

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Sun Y. Cotter F.I. Proctor Foundation, University of California San Francisco, San Francisco, California;

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Nicole E. Stoller F.I. Proctor Foundation, University of California San Francisco, San Francisco, California;

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Sheila K. West Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland;

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Robin L. Bailey Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom;

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Travis C. Porco F.I. Proctor Foundation, University of California San Francisco, San Francisco, California;
Department of Ophthalmology, University of California San Francisco, San Francisco, California;
Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California

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Bruce D. Gaynor F.I. Proctor Foundation, University of California San Francisco, San Francisco, California;
Department of Ophthalmology, University of California San Francisco, San Francisco, California;

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Jeremy D. Keenan F.I. Proctor Foundation, University of California San Francisco, San Francisco, California;
Department of Ophthalmology, University of California San Francisco, San Francisco, California;
Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California

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Thomas M. Lietman F.I. Proctor Foundation, University of California San Francisco, San Francisco, California;
Department of Ophthalmology, University of California San Francisco, San Francisco, California;
Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California

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Repeated oral azithromycin distribution targeted only to children has proven effective in reducing the ocular Chlamydia that causes trachoma. Here, we assess whether an enhanced coverage target of at least 90% of children is superior to the World Health Organization recommendation of at least 80%. Twenty-four trachoma-endemic communities in Matamèye, Niger, were randomized to a single day of azithromycin distribution aiming for at least 80% coverage or up to 4 days of treatment and > 90% coverage of children under age 12. All distributions were biannual. Children < 5 years of age and adults > 15 years were monitored for ocular Chlamydia infection by polymerase chain reaction every 6 months for 36 months in children and at baseline and 36 months in adults. Ocular Chlamydia prevalence in children decreased from 24.9% (95% confidence interval [CI] 15.9–33.8%) to 4.4% (95% CI 0.6–8.2%, P < 0.001) at 36 months in the standard coverage arm and from 15.6% (95% CI 10.0–21.2%) to 3.3% (95% CI 1.0–5.5%; P < 0.001) in the enhanced coverage arm. Enhanced coverage reduced ocular Chlamydia prevalence in children more quickly over time compared with standard (P = 0.04). There was no difference between arms at 36 months in children (2.4% lower with enhanced coverage, 95% CI 7.7–12.5%; P = 0.60). No infection was detected in adults at 36 months. Increasing antibiotic coverage among children from 80% to 90% may yield only short term improvements for trachoma control programs. Targeting treatment to children alone may be sufficient for trachoma control in this setting.

Author Notes

Address correspondence to Thomas M. Lietman, Francis I. Proctor Foundation, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94143. E-mail: tom.lietman@ucsf.edu

Financial support: This trial was funded by the Bill and Melinda Gates Foundation (PI S. K. W.).

Trial Registration: ClinicalTrials.gov NCT00792922.

Authors’ addresses: Catherine E. Oldenburg, Travis C. Porco, Jeremy D. Keenan, and Thomas M. Lietman, F.I. Proctor Foundation and Departments of Ophthalmology and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, E-mails: catherine.oldenburg@ucsf.edu, travis.porco@ucsf.edu, jeremy.keenan@ucsf.edu, tom.lietman@ucsf.edu. Abdou Amza, Boubacar Kadri, and Beido Nassirou, Programme FSS/Université Abdou Moumouni de Niamey, Programme National de Santé Oculaire, Niamey, Niger, E-mails: dr.amzaabdou@gmail.com, kadriboubacar@gmail.com, and nasbeido@yahoo.fr. Sun Y. Cotter and Nicole E. Stoller, F.I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, E-mails: sun.cotter@ucsf.edu and nicolestoller@gmail.com. Sheila K. West, Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Wilmer Eye Institute, Baltimore, MD, E-mail: shwest@jhmi.edu. Robin L. Bailey, Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Bloomsbury, London, United Kingdom, E-mail: robin.bailey@lshtm.ac.uk. Bruce D. Gaynor, F.I. Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, E-mail: bdgaynor@gmail.com.

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