title: Estimating the Future Impact of a Multi-Pronged Intervention Strategy on Ocular Disease Sequelae Caused by Trachoma: A Modeling Study.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: a Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , Victoria , Australia .
authors.forename: Manoj
authors.initials: M
authors.lastname: Gambhir
authors.affiliation: b Department of Infectious Disease Epidemiology , Imperial College London , London, UK .|c MRC Centre for Outbreak Analysis and Modelling , Department of Infectious Disease Epidemiology, Imperial College London , London, UK .
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Grassly
authors.affiliation: d Clinical Research Department , Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine , London , UK , and.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Burton
authors.affiliation: d Clinical Research Department , Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine , London , UK , and.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Solomon
authors.affiliation: e Indigenous Eye Health Unit, Melbourne School of Population Health, The University of Melbourne , East Melbourne, Victoria, Australia.
authors.forename: Hugh R
authors.initials: HR
authors.lastname: Taylor
authors.affiliation: d Clinical Research Department , Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine , London , UK , and.
authors.forename: David C
authors.initials: DC
authors.lastname: Mabey
authors.affiliation: b Department of Infectious Disease Epidemiology , Imperial College London , London, UK .|c MRC Centre for Outbreak Analysis and Modelling , Department of Infectious Disease Epidemiology, Imperial College London , London, UK .
authors.forename: Isobel M
authors.initials: IM
authors.lastname: Blake
authors.affiliation: b Department of Infectious Disease Epidemiology , Imperial College London , London, UK .
authors.forename: María-Gloria
authors.initials: MG
authors.lastname: Basáñez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001766:Blindness / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D004782:Environmental Health; D005260:Female; D014943:Global Health; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D006920:Hygiene; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D013508:Ophthalmologic Surgical Procedures; D015995:Prevalence; D014141:Trachoma / Q000453:epidemiology / Q000517:prevention & control*; D058457:Trichiasis / Q000453:epidemiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Blindness; Chlamydia trachomatis; elimination program; mathematical modeling; ocular sequelae