title: Assessment of a Novel Approach to Identify Trichiasis Cases Using Community Treatment Assistants in Tanzania.
abstract: BACKGROUND
  Simple surgical intervention advocated by the World Health Organization can alleviate trachomatous trichiasis (TT) and prevent subsequent blindness. A large backlog of TT cases remain unidentified and untreated. To increase identification and referral of TT cases, a novel approach using standard screening questions, a card, and simple training for Community Treatment Assistants (CTAs) to use during Mass Drug Administration (MDA) was developed and evaluated in Kongwa District, a trachoma-endemic area of central Tanzania.
  
  
  RESULTS
  A community randomized trial was conducted in 36 communities during MDA. CTAs in intervention villages received an additional half-day of training and a TT screening card in addition to the training received by CTAs in villages assigned to usual care. All MDA participants 15 years and older were screened for TT, and senior TT graders confirmed case status by evaluating all screened-positive cases. A random sample of those screened negative for TT and those who did not present at MDA were also evaluated by the master graders. Intervention CTAs identified 5.6 times as many cases (n = 50) as those assigned to usual care (n = 9, p < 0.05). While specificity was above 90% for both groups, the sensitivity for the novel screening tool was 31.2% compared to 5.6% for the usual care group (p < 0.05).
  
  
  CONCLUSIONS
  CTAs appear to be viable resources for the identification of TT cases. Additional training and use of a TT screening card significantly increased the ability of CTAs to recognize and refer TT cases during MDA; however, further efforts are needed to improve case detection and reduce the number of false positive cases.
authors.affiliation: Dana Center for Preventative Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Greene
authors.affiliation: Dana Center for Preventative Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Sheila K
authors.initials: SK
authors.lastname: West
authors.affiliation: Kongwa Trachoma Project, Kongwa, United Republic of Tanzania.
authors.forename: Harran
authors.initials: H
authors.lastname: Mkocha
authors.affiliation: Dana Center for Preventative Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Munoz
authors.affiliation: The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Shannath L
authors.initials: SL
authors.lastname: Merbs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D003150:Community Health Workers; D004501:Education, Medical / Q000379:methods; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008487:Medical History Taking / Q000379:methods; D008875:Middle Aged; D011795:Surveys and Questionnaires; D013636:Tanzania; D014141:Trachoma / Q000150:complications* / Q000175:diagnosis*; D058457:Trichiasis / Q000175:diagnosis* / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents