03381nas a2200469   4500000000100000008004100001653001600042653001300058653001300071653002400084653001600108653000900124653001100133653001100144653001100155653001100166653002700177653002100204653003300225653002600258653002100284653001000305653001700315653002600332653001000358653001500368100001200383700001300395700001400408700001100422700001600433700001400449700001300463700001200476700001500488245006200503856007800565300000900643490000600652520223900658022001402897       2010                            d10aYoung Adult10aTrachoma10aTanzania10aModels, Theoretical10aMiddle Aged10aMale10aInfant10aHumans10aGambia10aFemale10aFamily Characteristics10aEndemic Diseases10aCommunicable Disease Control10aChlamydia trachomatis10aChild, Preschool10aChild10aAzithromycin10aAnti-Bacterial Agents10aAdult10aAdolescent1 aBlake I1 aBurton M1 aSolomon A1 aWest S1 aBasáñez M1 aGambhir M1 aBailey R1 aMabey D1 aGrassly NC00aTargeting antibiotics to households for trachoma control.  uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2970531/pdf/pntd.0000862.pdf  ae8620 v43 a<p><strong>BACKGROUND: </strong>Mass drug administration (MDA) is part of the current trachoma control strategy, but it can be costly and results in many uninfected individuals receiving treatment. Here we explore whether alternative, targeted approaches are effective antibiotic-sparing strategies.</p>

<p><strong>METHODOLOGY/PRINCIPAL FINDINGS: </strong>We analysed data on the prevalence of ocular infection with Chlamydia trachomatis and of active trachoma disease among 4,436 individuals from two communities in The Gambia (West Africa) and two communities in Tanzania (East Africa). An age- and household-structured mathematical model of transmission was fitted to these data using maximum likelihood. The presence of active inflammatory disease as a marker of infection in a household was, in general, significantly more sensitive (between 79% [95%CI: 60%-92%] and 86% [71%-95%] across the four communities) than as a marker of infection in an individual (24% [16%-33%]-66% [56%-76%]). Model simulations, under the best fit models for each community, showed that targeting treatment to households has the potential to be as effective as and significantly more cost-effective than mass treatment when antibiotics are not donated. The cost (2007US$) per incident infection averted ranged from 1.5 to 3.1 for MDA, from 1.0 to 1.7 for household-targeted treatment assuming equivalent coverage, and from 0.4 to 1.7 if household visits increased treatment coverage to 100% in selected households. Assuming antibiotics were donated, MDA was predicted to be more cost-effective unless opportunity costs incurred by individuals collecting antibiotics were included or household visits improved treatment uptake. Limiting MDA to children was not as effective in reducing infection as the other aforementioned distribution strategies.</p>

<p><strong>CONCLUSIONS/SIGNIFICANCE: </strong>Our model suggests that targeting antibiotics to households with active trachoma has the potential to be a cost-effective trachoma control measure, but further work is required to assess if costs can be reduced and to what extent the approach can increase the treatment coverage of infected individuals compared to MDA in different settings.</p>
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