title: Relationship between Community Drug Administration Strategy and Changes in Trachoma Prevalence, 2007 to 2013.
abstract: Australia is the only high income country with persisting endemic trachoma. A national control program involving mass drug administration with oral azithromycin, in place since 2006, has some characteristics which differ from programs in low income settings, particularly in regard to the use of a wider range of treatment strategies, and more regular assessments of community prevalence. We aimed to examine the association between treatment strategies and trachoma prevalence.
  
  
  
  Through the national surveillance program, annual data from 2007-2013 were collected on trachoma prevalence and treatment with oral azithromycin in children aged 5-9 years from three Australian regions with endemic trachoma. Communities were classified for each year according to one of four trachoma treatment strategies implemented (no treatment, active cases only, household and community-wide). We estimated the change in trachoma prevalence between sequential pairs of years and across multiple years according to treatment strategy using random-effects meta-analyses.
  
  
  
  Over the study period, 182 unique remote Aboriginal communities had 881 annual records of both trachoma prevalence and treatment. From the analysis of pairs of years, the greatest annual fall in trachoma prevalence was in communities implementing community-wide strategies, with yearly absolute reductions ranging from -8% (95%CI -17% to 1%) to -31% (-26% to -37%); these communities also had the highest baseline trachoma prevalence (15.4%-43.9%). Restricting analyses to communities with moderate trachoma prevalence (5-19%) at initial measurement, and comparing community trachoma prevalence from the first to the last year of available data for the community, both community-wide and more targeted treatment strategies were associated with similar absolute reductions (-11% [-8% to -13%] and -7% [-5% to -10%] respectively). Results were similar stratified by region.
  
  
  
  Consistent with previous research, community-wide administration of azithromycin reduces trachoma prevalence. Our observation that less intensive treatment with a 'household' strategy in moderate prevalence communities (5-<20%) is associated with similar reductions in prevalence over time, will require confirmation in other settings if it is to be used as a basis for changes in control strategies.
authors.affiliation: School of Public Health and Community Medicine, UNSW, Sydney, Australia.
authors.forename: Bette
authors.identifier: 0000-0002-0787-5825
authors.initials: B
authors.lastname: Liu
authors.affiliation: The Kirby Institute, UNSW, Sydney, Australia.
authors.forename: Carleigh
authors.initials: C
authors.lastname: Cowling
authors.affiliation: School of Public Health and Community Medicine, UNSW, Sydney, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hayen
authors.affiliation: Centre for Disease Control, Northern Territory Department of Health, Darwin, Australia.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Watt
authors.affiliation: Communicable Disease Control Directorate, Health Department of Western Australia, Perth, Australia.|School of Medicine, University of Notre Dame Australia, Fremantle, Australia.
authors.forename: Donna B
authors.initials: DB
authors.lastname: Mak
authors.affiliation: UQ Child Health Research Centre, The University of Queensland, Brisbane, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lambert
authors.affiliation: Melbourne School of Population and Global Health, Carlton, Melbourne, Australia.
authors.forename: Hugh
authors.initials: H
authors.lastname: Taylor
authors.affiliation: The Kirby Institute, UNSW, Sydney, Australia.
authors.forename: John M
authors.initials: JM
authors.lastname: Kaldor
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D017963:Azithromycin / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D012111:Residence Characteristics; D014141:Trachoma / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin