ITI is a program of The Task Force for Global Health.
Population based trachoma prevalence surveys were conducted in 2008 in two districts – Mchinji in Central Region and Chikwawa in Southern Region, which indicated that both districts warranted three years of implementation of SAFE strategy for the elimination of trachoma as a public health problem. A Trachoma Action Plan was developed for the years 2011 – 2015, and a donation of Zithromax® was approved in November 2010. SAFE implementation started in 2011 in Chikwawa and Mchinji. In 2012 three more districts were surveyed, two of which, Nsanje and Salima, were found to warrant three years of SAFE implementation and started the following year.
Surveys were completed in the remaining districts suspected of being trachoma endemic by the end of 2013 and The Queen Elizabeth Diamond Jubilee Trust provided sufficient funding to scale up the program. Program implementation started in all districts in which at least three years of intervention were expected to be needed by the end of 2014. For those districts with a baseline prevalence of 5-9.9% TF, the TEC and ITI agreed to allocate the Malawian program sufficient Zithromax® for a single round of mass drug administration if the program would commit to adequately assess the coverage achieved, and conduct a second prevalence survey six months after the distribution. These districts would serve as a ‘real world’ study of how to manage trachoma in low prevalence areas – with a profound impact on the pace of the Global Program to eliminate trachoma. The single round MDA (mass drug administration) was conducted in eight districts with total population of 3.4m in 2015.
CURRENT IMPLEMENTATION STATUS
Several landmark moments were achieved in 2016. The three remaining districts that warranted three years of treatment were surveyed and found to be below the treatment threshold, now going into two years of surveillance to be followed by a survey to confirm program success in 2018. In addition, the eight five to nine percent districts serving as the critical real‐world demonstration of single round treatment were all surveyed in May/June and all were below the elimination threshold. This is a very important milestone for the Malawi program and the global program.
The two districts where the program first launched SAFE in 2011, Chikwawa and Mchinji, conducted the critical surveillance surveys that indicate whether trachoma can be said to have been eliminated as a public health problem. While Mchinji is the first district in which elimination has been achieved, a single additional round is required in Chikwawa.
To the surprise of the program, the final results for Chikwawa demonstrated that the prevalence of trachoma has risen above the treatment threshold once again and warranted another round of treatment. Impact surveys are scheduled in Dedza, Chikwawa, Lilongwe rural, and Nkhota Kota districts in 2017.
Zithromax® Shipments by Year