UCSF Proctor Foundation for Research in Ophthalmology

Eradicating trachoma, once and for all Highly Ranked

Eye diseases

Trachoma was once the world’s leading cause of blindness, but with our three-fold approach, it will become the second human disease to be completely eradicated.

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Lead Organization

UCSF Proctor Foundation for Research in Ophthalmology

San Francisco, California, United States


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Project Summary

Trachoma is a bacterial disease of the eye leading to irreversible blindness and affecting nearly 2 million people worldwide. A decade of intervention has resulted in trachoma control in the majority of previously endemic regions, but progress has stalled in some difficult-to-control regions in sub-Saharan Africa. Mathematical models and clinical trials show that existing strategies will not work in these “hotspots.” Unless infection is rapidly eliminated in remaining areas, antimicrobial resistance could derail progress. Eradication of trachoma—the permanent reduction of cases to zero—is a sustainable solution that has now become achievable. We propose to use novel methods and technology to eliminate infection from these hard-to-treat regions. Through intensified and more frequent treatment, we will eliminate infection among “super-spreaders” to prevent further transmission. Finally, we will build new global labs for monitoring and rapid case detection. Through this new approach, we will eradicate trachoma forever.

Problem Statement

Trachoma affects the most disadvantaged people in the poorest countries. Approximately 142 million people are at risk for trachoma blindness. Pre-school children harbor the majority of the infection, while the blinding complications from scarring and inturned eyelids occur in adults and the elderly. Surgery can repair the eyelids, but the inturned lashes often return and lead to blindness. The economic burden due to trachoma is enormous and often creates a cycle of poverty. By treating or preventing the initial infection, we can thwart these devastating outcomes.Despite decades of study, we do not know why some areas have more trachoma than others. Programmatic interventions have controlled trachoma in many parts of the world, but infection continues to ravage other countries. Current strategies involve the ‘SAFE’ method which includes surgery, antibiotics, facial cleanliness, and environmental improvement to reduce infection. While hygiene is associated with the disease, no hygiene intervention has been shown to reduce infection. Most of the world’s trachoma is in Ethiopia; despite many SAFE interventions, trachoma reduction has been less successful there. What is clear is that the current strategy of mass annual azithromycin and hygiene measures is not necessary in some areas and is not sufficient in others. The largest impact can be achieved by focusing and intensifying efforts on the regions where current interventions are not successful.

Solution Overview

Our approach starts with redefining the goal: from control of infection to global eradication. To achieve eradication, we propose to use the latest technology to classify districts, focus and intensify efforts where necessary, and intensely monitor eradication.Classification. The current one-size-fits-all approach to trachoma control has been successful in many areas. However, some areas where the approach is less effective require more intensive treatment. We will make use of new diagnostic tests and technology that were unavailable 20 years ago to classify regions into those 1) where the current strategy is unnecessary; 2) where the strategy is useful and sufficient; and 3) hotspots where the strategy needs to be supplemented. Focus and intensify efforts. We will focus additional rounds of treatments on the core group of “super-spreaders”, essentially removing them from the transmission process. Super spreaders are those that drive transmission disproportionately, infecting secondary hosts. By focusing on this group of people, often young children, we can make better use of programmatic resources. Monitor infection. We will assess results and adapt strategies in real time. Local elimination of infection will be assessed with state-of-the-art labs located in the affected regions. PCR laboratories will be installed as well as photo-grading centers. We will survey regions for recrudescence using serology and smartphone photos, graded by machine-learning algorithms, implemented in local areas. Currently programs rely on existing health workers. We propose to use a separate trachoma corps for monitoring and treatment. Doing so will enable us to have a dedicated team of boots-on-the-ground.

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