ITI is a program of The Task Force for Global Health.
Tanzania has been known to be endemic for many years and efforts to control trachoma date back to the 1980’s with both Helen Keller International (HKI) and Johns Hopkins (JHU) conducting programs and research respectively. The goal of one JHU study was to determine why some families were free of trachoma while others were chronically inflicted. The study looked at transmission of the disease, the role of fly control as well as that of personal hygiene with the intention of using the data to develop and test a new public health intervention. This research led to community intervention trials for face-washing. These efforts would eventually factor into the conception of the SAFE strategy - the four prong WHO endorsed strategy that is now the foundation of all trachoma control programs. Tanzania was one of the three countries along with Egypt and the Gambia to participate in the Azithromycin in the Control of Trachoma (ACT) clinical trials which eventually led to the inclusion of azithromycin as the drug of choice for the A of the SAFE strategy. This in turn spurred the donation of Zithromax® by Pfizer and the establishment of the International Trachoma Initiative (ITI).
Though trachoma has long been recognized as a public health problem in Tanzania, a national effort to map the disease did not take place until 2004 continuing on into 2006. Fifty districts were identified as being endemic, having a TF prevalence of greater than 10%. Further baseline mapping has been conducted since 2012/2013 and a number of districts have also conducted impact surveys following the requisite rounds of Zithromax® distribution. The recent data indicates that Tanzania has made enormous progress in the reduction of active trachoma with only 16 districts currently above the 5% threshold defining a public health problem.
Tanzania was one of the first countries to receive the Zithromax® donation, beginning MDA in 1999 in the Kongwa District. As the country scaled up, however, a number of challenges presented themselves causing low coverage and missed rounds of MDA. In 2010, trachoma was shifted from the National Eye Care Program to the NTD program. With the NTD program’s experience in MDA and with significant changes in ITI, the country has made significant progress in treatment witnessed by the number of districts no longer requiring drug. Tanzania’s target year of elimination is 2020.
CURRENT IMPLEMENTATION STATUS
- Currently Tanzania benefits from funding from USAID for MDA with Zithromax®, and funding from DFID and the Queen Elizabeth Diamond Jubilee Trust (Trust) for trichiasis management.
- The national program participated in the 2015 and hosted the 2016 East Africa Cross Border meeting. The 2016 meeting attracted seventy-six participants including individuals from the Ministry of Health from Eritrea, Ethiopia, Kenya, South Sudan, Sudan, Tanzania and Uganda in addition to public health experts from the UK, USA and Ethiopia.
- Tanzania was the first country to negotiate a three year MOU with ITI (2016 - 2018) which will streamline the administrative process associated with the Zithromax® shipment.
- A successful TAP workshop took place in March 2017; a finalized document will be ready for the AJPM scheduled for June 2017.
- In previous program years, the national program struggled due to political and bureaucratic matters within the Ministry to clear the Zithromax® shipment in a timely manner which resulted in delayed MDAs.
- Delayed funding stream in turn delayed MDAs in 2016 with many occurring in Q1 2017.
- In 2016, mal-distribution occurred in the Meatu district.
- Political and administrative boundaries constantly change. District splits skew population numbers, which impacts treatment decisions and coverage rates.
- Several districts with hyper endemicity continue to pose a challenge to eliminating blinding trachoma in particular the Arusha region: (1) Longido (57.6%), (2) Monduli (57.6%) and (3) Ngorongoro (52.5%), but the cross-border sub-regional committees are working on strategies to treat these communities.
- Several 5-9 districts struggle with persistent 5-9 survey results. In particular, Dodoma/Chamwino (2015: 7.7%, 2016 9.6%), Singida/Manyoni (2014: 5.8%, 2015: 6.1%, 2016: 5.6%) and Rukwa/Kalambo (2015: 5.6%, 2016: 9.1%). To address this matter, a TEC recommendation was made offering funding support for operational research to research the issue.
Zithromax® Shipments by Year
Kongwa Trachoma Project