Partnership for Rapid Elimination of Trachoma

NCT00792922 | Completed Phase 4 Results DMC

• 1 other identifier: NA_00018439
• Study Type: interventional
• Target: 128
• Locations: 2 countries
• Sites: 3

Brief Summary

Trachoma, an ocular infection caused by C. trachomatis, is the second leading infectious cause of blindness worldwide. Years of repeated infection with C. trachomatis cause the eyelid to scar and contract and ultimately to rotate inward such that the eyelashes rub against the eyeball and abrade the cornea (trichiasis). The World Health Organization (WHO) has endorsed a multi-faceted strategy to combat trachoma, which includes the use of antibiotic treatment to reduce the community pool of infection with C. trachomatis. The objective of this study is to conduct a randomized, community-based trial in three countries (Niger, Tanzania and The Gambia), representing different baseline endemicities, of alternative coverages and frequencies of administration of mass antibiotic treatment as well as to determine the cost-effectiveness of these different strategies from a program perspective.

Conditions

Trachoma

Keywords

Trachoma; Azithromycin; Mass treatment

Outcome Measures

Primary Outcomes (2)

• Community Prevalence of Trachoma and Ocular C. Trachomatis (CT) Infection at Baseline

  Mass drug administration (MDA) with azithromycin or topical tetracycline is recommended by World Health Organization (WHO) for 3 years in districts where the prevalence of trachoma is\>=10 % in children aged 1-9 years. The prevalence of trachoma (TF) was measured using the Simplified WHO Grading System. Both eyelids were everted and tarsal conjunctiva graded for signs of clinical trachoma. Ocular photographs of right eye were taken on random samples of sentinel children to determine the drift in grading over time. To detect CT infection, an ocular swab of the right eye using a Dacron swab was collected from the sentinel kids. The swab was stored dry, and frozen until shipped and processed in the laboratory. Air control swabs were also taken to test for field and laboratory contamination.

  At baseline

• Community Prevalence of Trachoma and Ocular C. Trachomatis (CT) Infection at 36 Months

  100 random sentinel children aged 0- 5 years per community were to be examined for prevalence of trachoma \& CT infection in Tanzania \& Gambia. 50-100 random sentinel children aged 0-5 years per community were to be examined in Niger per community for prevalence of TF and CT infection. Outcomes are reported at the community level because raw data could not be accessed. There is no way to determine how many participants were examined in each arm.

  3 years

Study Arms (4)

≥90% coverage with azithromycin target

ACTIVE COMPARATOR

Selected communities will receive mass treatment annually for three years.

Drug: Azithromycin

80%-89% coverage with azithromycin target

ACTIVE COMPARATOR

Selected communities will receive mass treatment annually for three years.

Drug: Azithromycin

≥90% coverage with azithromycin , treatment based

ACTIVE COMPARATOR

Treatment to be administered at baseline then continued yearly if trachoma prevalence is greater than 5% In Niger, treatment will be every 6-months for children ages twelve and under.

Drug: Azithromycin

80%-89% coverage with azithromycin : treatment based

ACTIVE COMPARATOR

Treatment to be administered at baseline then continued yearly if trachoma prevalence is greater than 5% In Niger, treatment will be every 6-months for children ages twelve and under.

Drug: Azithromycin

Interventions

Azithromycin DRUG

Comparison of community coverage rate

Also known as: Zithromax

80%-89% coverage with azithromycin target; ≥90% coverage with azithromycin target

Eligibility Criteria

• Age: Up to 5 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17)

You may qualify if:

• Communities are located in the target districts and accessible by vehicle
• The community leaders consent to have the community enrolled
• Rapid assessment and/or available data suggest trachoma rates are higher than 20% in the community.
• The community size is \<5,000 persons or \>250 persons.
• The child is age 5 years or younger
• The child must be a resident in an eligible, sample community (defined as either living in the community since birth, or moved in with parents or guardians).
• The child must not have an ocular condition that would preclude grading trachoma or taking an ocular specimen.
• The child must be willing to have a swab taken as part of being a sentinel child (this is critical for The Gambia and Tanzania, as each swab result counts towards meeting the stopping rule)
• The child must have an identifiable guardian capable of providing consent to participate.

Sponsors & Collaborators

• Johns Hopkins University: lead
• Bill and Melinda Gates Foundation: collaborator

Study Sites (3)

UCSF Proctor Foundation

San Francisco, California, 94143, United States

Location

Johns Hopkins University

Baltimore, Maryland, 21205, United States

Location

London School of Hygiene and Tropical Medicine

London, WC1E 7HT, United Kingdom

Location

Related Publications (19)

• Oldenburg CE, Amza A, Cooley G, Kadri B, Nassirou B, Arnold BF, Rosenthal PJ, O'Brien KS, West SK, Bailey RL, Porco TC, Keenan JD, Lietman TM, Martin DL. Biannual versus annual mass azithromycin distribution and malaria seroepidemiology among preschool children in Niger: a sub-study of a cluster randomized trial. Malar J. 2019 Dec 3;18(1):389. doi: 10.1186/s12936-019-3033-2.

  PMID: 31796025 DERIVED

• Kim JS, Oldenburg CE, Cooley G, Amza A, Kadri B, Nassirou B, Cotter SY, Stoller NE, West SK, Bailey RL, Keenan JD, Gaynor BD, Porco TC, Lietman TM, Martin DL. Community-level chlamydial serology for assessing trachoma elimination in trachoma-endemic Niger. PLoS Negl Trop Dis. 2019 Jan 28;13(1):e0007127. doi: 10.1371/journal.pntd.0007127. eCollection 2019 Jan.

  PMID: 30689671 DERIVED

• Keenan JD, Chin SA, Amza A, Kadri B, Nassirou B, Cevallos V, Cotter SY, Zhou Z, West SK, Bailey RL, Porco TC, Lietman TM; Rapid Elimination of Trachoma (PRET) Study Group. The Effect of Antibiotic Selection Pressure on the Nasopharyngeal Macrolide Resistome: A Cluster-randomized Trial. Clin Infect Dis. 2018 Nov 13;67(11):1736-1742. doi: 10.1093/cid/ciy339.

  PMID: 29897440 DERIVED

• O'Brien KS, Cotter SY, Amza A, Kadri B, Nassirou B, Stoller NE, Zhou Z, West SK, Bailey RL, Keenan JD, Porco TC, Lietman TM. Childhood Mortality After Mass Distribution of Azithromycin: A Secondary Analysis of the PRET Cluster-randomized Trial in Niger. Pediatr Infect Dis J. 2018 Nov;37(11):1082-1086. doi: 10.1097/INF.0000000000001992.

  PMID: 29561511 DERIVED

• Oldenburg CE, Amza A, Kadri B, Nassirou B, Cotter SY, Stoller NE, West SK, Bailey RL, Porco TC, Gaynor BD, Keenan JD, Lietman TM. Comparison of Mass Azithromycin Coverage Targets of Children in Niger: A Cluster-Randomized Trachoma Trial. Am J Trop Med Hyg. 2018 Feb;98(2):389-395. doi: 10.4269/ajtmh.17-0501. Epub 2017 Dec 14.

  PMID: 29260659 DERIVED

• Oldenburg CE, Amza A, Kadri B, Nassirou B, Cotter SY, Stoller NE, West SK, Bailey RL, Porco TC, Keenan JD, Lietman TM, Gaynor BD. Annual Versus Biannual Mass Azithromycin Distribution and Malaria Parasitemia During the Peak Transmission Season Among Children in Niger. Pediatr Infect Dis J. 2018 Jun;37(6):506-510. doi: 10.1097/INF.0000000000001813.

  PMID: 29088030 DERIVED

• Amza A, Kadri B, Nassirou B, Cotter SY, Stoller NE, West SK, Bailey RL, Porco TC, Gaynor BD, Keenan JD, Lietman TM, Oldenburg CE. Effectiveness of expanding annual mass azithromycin distribution treatment coverage for trachoma in Niger: a cluster randomised trial. Br J Ophthalmol. 2018 May;102(5):680-686. doi: 10.1136/bjophthalmol-2017-310916. Epub 2017 Sep 11.

  PMID: 28893761 DERIVED

• Bojang E, Jafali J, Perreten V, Hart J, Harding-Esch EM, Sillah A, Mabey DC, Holland MJ, Bailey RL, Roca A, Burr SE. Short-term increase in prevalence of nasopharyngeal carriage of macrolide-resistant Staphylococcus aureus following mass drug administration with azithromycin for trachoma control. BMC Microbiol. 2017 Mar 28;17(1):75. doi: 10.1186/s12866-017-0982-x.

  PMID: 28351345 DERIVED

• Amza A, Kadri B, Nassirou B, Cotter SY, Stoller NE, Zhou Z, Bailey RL, Mabey DC, Porco TC, Keenan JD, Gaynor BD, West SK, Lietman TM. A Cluster-Randomized Trial to Assess the Efficacy of Targeting Trachoma Treatment to Children. Clin Infect Dis. 2017 Mar 15;64(6):743-750. doi: 10.1093/cid/ciw810.

  PMID: 27956455 DERIVED

• Liu F, Porco TC, Amza A, Kadri B, Nassirou B, West SK, Bailey RL, Keenan JD, Lietman TM. Short-term forecasting of the prevalence of clinical trachoma: utility of including delayed recovery and tests for infection. Parasit Vectors. 2015 Oct 22;8:535. doi: 10.1186/s13071-015-1115-8.

  PMID: 26489933 DERIVED

• Liu F, Porco TC, Amza A, Kadri B, Nassirou B, West SK, Bailey RL, Keenan JD, Solomon AW, Emerson PM, Gambhir M, Lietman TM. Short-term Forecasting of the Prevalence of Trachoma: Expert Opinion, Statistical Regression, versus Transmission Models. PLoS Negl Trop Dis. 2015 Aug 24;9(8):e0004000. doi: 10.1371/journal.pntd.0004000. eCollection 2015 Aug.

  PMID: 26302380 DERIVED

• Burr SE, Hart J, Edwards T, Harding-Esch EM, Holland MJ, Mabey DC, Sillah A, Bailey RL. Anthropometric indices of Gambian children after one or three annual rounds of mass drug administration with azithromycin for trachoma control. BMC Public Health. 2014 Nov 18;14:1176. doi: 10.1186/1471-2458-14-1176.

  PMID: 25407464 DERIVED

• Gaynor BD, Amza A, Gebresailassie S, Kadri B, Nassirou B, Stoller NE, Yu SN, Cuddapah PA, Keenan JD, Lietman TM. Importance of including borderline cases in trachoma grader certification. Am J Trop Med Hyg. 2014 Sep;91(3):577-9. doi: 10.4269/ajtmh.13-0658. Epub 2014 Jul 7.

  PMID: 25002297 DERIVED

• Hart JD, Edwards T, Burr SE, Harding-Esch EM, Takaoka K, Holland MJ, Sillah A, Mabey DC, Bailey RL. Effect of azithromycin mass drug administration for trachoma on spleen rates in Gambian children. Trop Med Int Health. 2014 Feb;19(2):207-11. doi: 10.1111/tmi.12234. Epub 2014 Jan 17.

  PMID: 24433194 DERIVED

• Harding-Esch EM, Sillah A, Edwards T, Burr SE, Hart JD, Joof H, Laye M, Makalo P, Manjang A, Molina S, Sarr-Sissoho I, Quinn TC, Lietman T, Holland MJ, Mabey D, West SK, Bailey R; Partnership for Rapid Elimination of Trachoma (PRET) study group. Mass treatment with azithromycin for trachoma: when is one round enough? Results from the PRET Trial in the Gambia. PLoS Negl Trop Dis. 2013 Jun 13;7(6):e2115. doi: 10.1371/journal.pntd.0002115. Print 2013.

  PMID: 23785525 DERIVED

• Yohannan J, Munoz B, Mkocha H, Gaydos CA, Bailey R, Lietman TA, Quinn T, West SK. Can we stop mass drug administration prior to 3 annual rounds in communities with low prevalence of trachoma?: PRET Ziada trial results. JAMA Ophthalmol. 2013 Apr;131(4):431-6. doi: 10.1001/jamaophthalmol.2013.2356.

  PMID: 23392481 DERIVED

• Amza A, Kadri B, Nassirou B, Yu SN, Stoller NE, Bhosai SJ, Zhou Z, McCulloch CE, West SK, Bailey RL, Keenan JD, Lietman TM, Gaynor BD. The easiest children to reach are most likely to be infected with ocular Chlamydia trachomatis in trachoma endemic areas of Niger. PLoS Negl Trop Dis. 2013;7(1):e1983. doi: 10.1371/journal.pntd.0001983. Epub 2013 Jan 10.

  PMID: 23326612 DERIVED

• Amza A, Kadri B, Nassirou B, Stoller NE, Yu SN, Zhou Z, Chin S, West SK, Bailey RL, Mabey DC, Keenan JD, Porco TC, Lietman TM, Gaynor BD; PRET Partnership. Community risk factors for ocular Chlamydia infection in Niger: pre-treatment results from a cluster-randomized trachoma trial. PLoS Negl Trop Dis. 2012;6(4):e1586. doi: 10.1371/journal.pntd.0001586. Epub 2012 Apr 24.

  PMID: 22545165 DERIVED

• Harding-Esch EM, Edwards T, Mkocha H, Munoz B, Holland MJ, Burr SE, Sillah A, Gaydos CA, Stare D, Mabey DC, Bailey RL, West SK; PRET Partnership. Trachoma prevalence and associated risk factors in the gambia and Tanzania: baseline results of a cluster randomised controlled trial. PLoS Negl Trop Dis. 2010 Nov 2;4(11):e861. doi: 10.1371/journal.pntd.0000861.

  PMID: 21072224 DERIVED

MeSH Terms

Conditions

Trachoma

Interventions

Azithromycin

Condition Hierarchy (Ancestors)

Conjunctivitis, Bacterial; Eye Infections, Bacterial; Bacterial Infections; Bacterial Infections and Mycoses; Infections; Chlamydia Infections; Chlamydiaceae Infections; Gram-Negative Bacterial Infections; Eye Infections; Conjunctivitis; Conjunctival Diseases; Eye Diseases; Corneal Diseases

Intervention Hierarchy (Ancestors)

Erythromycin; Macrolides; Polyketides; Lactones; Organic Chemicals

Results Point of Contact

• Title: Sheila K West
• Organization: Johns Hopkins University

shwest@jhmi.edu

410 955 2606

Study Officials

• Sheila West, PhD

  Johns Hopkins University

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: FACTORIAL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: The study was a factorial study model to begin with in all 3 countries (Niger,Tanzania and Gambia) but because we never stopped treatment in Tanzania and Niger site.Hence the study design was collapsed to a simple design in Tanzania and Niger.The study model was kept as a factorial design for the Gambia site. Protocol Enrollment refers to the number of communities, not the number of participants enrolled.

Study Record Dates

• First Submitted: November 17, 2008
• First Posted: November 18, 2008
• Study Start: May 1, 2008
• Primary Completion: June 1, 2013
• Study Completion: June 1, 2014
• Last Updated: July 18, 2017
• Results First Posted: July 18, 2017

Record last verified: 2017-06

Data Sharing

• IPD Sharing: Will not share

Locations

GB (1); US (2)