Cost and community acceptability of enhanced antibiotic distribution approaches for trachoma in the Republic of South Sudan: enhancing the A in SAFE (ETAS) study protocol

The World Health Organization targeted trachoma for global elimination as a public health problem by 2030. Reaching elimination thresholds by the year 2030 in the Republic of South Sudan will be a considerable challenge, as the country currently has many counties considered hyper-endemic (> 30% t...

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Published in:	BMC ophthalmology Vol. 23; no. 1; p. 51
Main Authors:	Sanders, Angelia M, Makoy, Samuel, Deathe, Andrew R, Ohidor, Stephen, Jesudason, Timothy C, Nute, Andrew W, Odongi, Patrick, Boniface, Lochebe, Abuba, Stella, Delahaut, Alexis S, Sebit, Wilson, Niquette, James, Callahan, E Kelly, Walker, Damian G, Nash, Scott D
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 06-02-2023 BioMed Central BMC
Subjects:	Age groups Analysis Anti-Bacterial Agents - therapeutic use Antibiotics Child Cost control Drug dosages Economic aspects Humanitarianism Humans Infant Inflammation - drug therapy Mass drug administration Mixed methods research Ophthalmology Population studies Prevalence Public health South Sudan Study Protocol Surgery Surveys Surveys and Questionnaires Trachoma Trachoma - drug therapy Trachoma - epidemiology South Sudan Sudan South Sudan Trachoma Mass drug administration
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Summary:	The World Health Organization targeted trachoma for global elimination as a public health problem by 2030. Reaching elimination thresholds by the year 2030 in the Republic of South Sudan will be a considerable challenge, as the country currently has many counties considered hyper-endemic (> 30% trachomatous inflammation-follicular [TF]) that have yet to receive interventions. Evidence from randomized trials, modeling, and population-based surveys suggests that enhancements may be needed to the standard-of-care annual mass drug administration (MDA) to reach elimination thresholds in a timely manner within highly endemic areas. We describe a protocol for a study to determine the cost and community acceptability of enhanced antibiotic strategies for trachoma in South Sudan. The Enhancing the A in SAFE (ETAS) study is a community randomized intervention costing and community acceptability study. Following a population-based trachoma prevalence survey in 1 county, 30 communities will be randomized 1:1 to receive 1 of 2 enhanced MDA interventions, with the remaining communities receiving standard-of-care annual MDA. The first intervention strategy will consist of a community-wide MDA followed by 2 rounds of targeted treatment to children ages 6 months to 9 years, 2 weeks and 4 weeks after the community MDA. The second strategy will consist of a community-wide biannual MDA approximately 6 to 8 months apart. The costing analysis will use a payer perspective and identify the total cost of the enhanced interventions and annual MDA. Community acceptability will be assessed through MDA coverage monitoring and mixed-methods research involving community stakeholders. A second trachoma-specific survey will be conducted 12 months following the original survey. ETAS has received ethical clearance and is expected to be conducted between 2022 and 2023. Results will be shared through subsequent manuscripts. The study's results will provide information to trachoma programs on whether enhanced interventions are affordable and acceptable to communities. These results will further help in the design of future trachoma-specific antibiotic efficacy trials. Enhanced MDA approaches could help countries recover from delays caused by conflict or humanitarian emergencies and could also assist countries such as South Sudan in reaching trachoma elimination as a public health problem by 2030. This trial was registered on December 1 , 2022 (clinicaltrails.org: NCT05634759).
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1471-2415 1471-2415
DOI:	10.1186/s12886-023-02783-x