Click to edit Master title style• Click to edit Master text styles      – Second level           • Third level            ...
Click to edit Master title style• Click to edit Master text styles      – Second level           • Third level            ...
What is trachoma?               Click to edit Master title style• Trachoma is the leading cause of    • preventable blindn...
What is trachoma?            Click to edit Master title style•Every 4 minutes, 1 person experiences • Click to edit Master...
Click to edit Master title style• Click to edit Master text styles      – Second level           • Third level            ...
What is “2020 INSight”?           Click to edit Master title style• Outline of this strategic plan is structured around fo...
Click to edit Master title style• Click to edit Master text styles      – Second level           • Third level            ...
Where are we?           Click to edit Master title style• 110 million people need treatment in confirmed endemic• areas to...
Where are we?                        SAFE Strategy           Click to edit Master title style• Click to edit Master text s...
Where are we?                     TrachomaCoalition.org           Click to edit Master title style• Click to edit Master t...
Where are we?                        TrachomaAtlas.org           Click to edit Master title style• Click to edit Master te...
Click to edit Master title style• Click to edit Master text styles      – Second level           • Third level            ...
Where do we want to go?           Click to edit Master for antibiotics scale-up   Model for surgery scale-up              ...
Click to edit Master title style• Click to edit Master text styles      – Second level           • Third level            ...
How do we get there?           Click to edit Master title styleGuiding principles of elimination plan:• Click to editneed ...
How do we get there?                                                                                Milestones to 2020    ...
Click to edit Master title style • Click to edit Master text styles       – Second level            • Third level         ...
What is the cost of elimination?               Click to edit Master title styleUSD                             Elimination...
Click to edit Master title style• Click to edit Master text styles      – Second level      The•challenge for the coming y...
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A global strategy to eliminate blinding trachoma

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Trachoma is the leading cause of preventable blindness worldwide. This presentation describes a global strategy to eliminate blinding trachoma.

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  • Blinding trachoma, one of the oldest known infectious eye diseases, may be facing its end gameA new global strategic plan- 2020 INSight- created by an international coalition of partners, lays out specific actions to take and milestones to meet to eliminate blinding trachoma by the year 2020
  • “We Can Eliminate Trachoma” video produced by Fred Hollows Foundation(3 minutes)
  • This moving film shows that elimination is possibleTrachoma is the leading cause of preventable blindness, and mainly affects the poorest areas of the worldIt is a bacterial infection that leads to chronic eye inflammationRe-infection, scarring, and trauma to the cornea lead to an advanced stage of the disease, TT (Trachomatistrichiasis), which is a very painful condition in which the eyelashes turn inward and scrape the cornea4.6 million people live with this advanced stage of trachoma; they face visual impairment or blindnessTypically, children are infected at an early age and develop vision loss later in life
  • Eliminating blinding trachoma is a critical goal in the international health community, since every 4 minutes, 1 person experiences severe sight loss because of trachoma, and every hour, 4 people become blindTECHNICAL AUDIENCE DEFINITIONWHO defines trachoma elimination as achieving a TF (Trachomatous Follicular) prevalence of less than 5% in children 1-9 years old, AND a TT (TrachomatousTrichiasis) prevalence of less than 1 per 100 in the total population of a district LAY AUDIENCE DEFINITION WHO defines trachoma elimination as a combination of reducing the active disease in a population and reducing the backlog of Trichiasis, the blinding stage of the disease.
  • With this understanding of trachoma and its presence in the poorest communities in the developing world, I want to introduce you to “2020 INSight”
  • Again, 2020 INSight is a global strategic plan with crucial next steps toward eliminating blinding trachoma by the year2020The outline of the plan is structured around 4 questions:Where are we  Reviews the current state of trachoma prevalence and elimination effortsWhere do we want to go  Provides an overview of the interventions needed to eliminate trachomaHow do we get there  Highlights milestones for progress to eliminating blinding trachoma by 2020What is the cost of eliminating blinding trachoma  Reviews the costs associated with this strategic plan
  • The first step in eliminating blinding trachoma is to ask ourselves- Where are we in this elimination process?
  • Right now, 110 million people need treatment for trachoma in confirmed endemic area and 210 million more live in areas where trachoma is suspected to be endemicThese populations cover 59 countries where trachoma is suspected to be endemic14 (24%) of these countries carry 80% of the burdenTrachoma control programs use the World Health Organization-endorsed SAFE strategy to work toward eliminating trachomaThe main components of this strategy are Surgery, Antibiotics, Facial cleanliness, and Environmental improvementsSignificant progress has been made using the SAFE strategy- 9 countries have achieved WHO ultimate intervention goals-but urgent intervention is still needed in many countriesFinally, there is a strong spirit of collaboration among organizations that belong to the International Coalition for Trachoma Control
  • WHO SAFE strategy consists of 4 components:Surgery- is needed to stop lashes from rubbing against the cornea, which then stops the cycle of trauma and secondary infection that leads to blindnessThe procedure is simple enough to be performed by trained health care workersAntibiotics- are key to treating infection and decreasing the prevalence and transmission of trachoma in endemic regionsMDAs (Mass Drug Administration) get these antibiotics to burdened populationsThese are made possible by drug donation programs, such Pfizer’s $10 billion donation of Zithromax®, which is managed by the International Trachoma InitiativeFacial cleanliness- is the behavioral component of this strategy, which helps reduce the transmission of bacteria with health education about facial hygieneInitiatives within this component work to educate individuals and communities about the transmission cycle of the diseaseEnvironmental improvements- reduce exposure and re-infection by increasing people’s access to clean, bacteria-free waterFor example, constructing new latrines improves basic sanitation
  • The implementation of the SAFE strategy requirescollaboration among trachoma control programs and the sharing of resources, such as ICTC’s website, TrachomaCoalition.orgThe site provides downloadable maps showing where the SAFE strategy is being used around the worldFor example, these maps showcoverage of each component in highly endemic districts of EthiopiaTrachomaCoalition.org also links to coalition member websites and other resources
  • Other resources include TrachomaAtlas.org, which is an open-access site with updated maps of the geographical distribution of trachomaThese maps are freely accessible to countries, partners, and the publicThis is an example of a map from the Trachoma Atlas website, showing the prevalence of trachoma on the African continentMaps can be downloaded according to a country, region, or district
  • The next phase of the 2020INSight plan asks “Where do we want to go?”, and provides an overview of exactly what interventions are needed to eliminate trachoma
  • Again, our goal is to eliminate blinding trachoma by 2020, which gives us 9 yearsTo achieve this, we must scale up interventions at each level of WHO’s SAFE strategy2020 INSight has modeled scale-up scenarios to help us understand how this process will work On the left isa model for scale-up of surgery, showing the impact of increasing the number of surgeries (yellow bars) on the backlog of patients (purple line)We need to address the backlog of about 4.6 million people needing surgery in confirmed districtsIt is important to note that the capacity for surgery needs to remain beyond 2020 to ensure that future patients (those already on their way to developing TT) will be able to receive treatmentOn the right isa model for scale-up of antibiotics, showing the impact of increasing MDAs (yellow bars) on the number of people remaining in confirmed endemic areas (purple line)200 million treatments have already been distributed, but we need 380 million more treatments for confirmed districts aloneScale-up also needs to happen for F & E components of the SAFE strategy, which will mean continuing facial-cleansing initiatives in existing districts and starting them in 500 new districts and collaborating with NTD (Neglected Tropical Disease), WASH (Water/Sanitation/Hygiene), and education sectors to dramatically increase access to clean water and latrines
  • How do we get there?This phase of 2020 INSight highlights the milestones for progress to achieve this scale-up and reach our elimination goal
  • Guiding principles of 2020INSight elimination plan:1. UrgencyThere is an urgent need for action in order to eliminate blinding trachomain the next 9 years We want to aim for fastest timeline possible in each district, beginning by focusing on high-burden countries2. Accountable ownershipCountries should lead their own elimination process from planning to implementation, and should be responsible for integrating trachoma control into national health servicesPrograms such as ITI can help to solicit & coordinate contributions from donors, but in the end, each country is responsible to their own people3. Integration Trachoma-focused efforts should be integrated with other initiatives within the broader NTD community and with programs focused on health education and environmental improvements4. Efficient, coordinated partnershipsAll partners and stakeholders in the trachoma field should coordinate their activities to maximize impact and avoid doing the same work twice5. Tailored local interventions Programs should plan according to WHO guidelines, but tailor specific interventions to the each country and the local needs of each district, building on strategies that have been shown to work and using the best available local knowledge
  • 2020INSight also gives up this timeline map of milestones to elimination and provides targets for when each step of the process should be accomplished(This graphic can be viewed in more detail in the 2020INSight book)While this timeline stops in 9 years, part of the 2020INSight strategy is to plan beyond elimination, with long-term intentions to have systems in place that will allow for sustained trachoma monitoring and control after 2020
  • The last phase of the 2020INSight strategic plan addresses what it will cost to eliminate blinding trachoma
  • Even conservative estimates suggest that the annual loss of productivity due to trachoma is between $3-6 billionEstimated cost of all interventions to address confirmed disease burden is $430 millionIf, indeed, 50% of suspected districts are confirmed, this cost will increase to $748 millionMost of this money is needed for surgery, environmental improvements, and antibiotic distribution [Elimination costs breakdown –FYI]Surgery (42%) $182 million Environment (26%) $112 million Antibiotics (22%) $94 millionFace-washing (7%) $28 millionData gathering (3%) $14 millionWhen we look at these costs, it is also important to ask, What are the savings?Eliminating the disease in Africa alone would boost the continent’s GDP 20-30 percentage points based on conservative annual productivity loss estimatesIt would also break the cycle of poverty and human suffering that traps many individuals and communities across the globe
  • The challenge of eliminating blinding trachoma by 2020 is considerable, but with the momentum of our partnerships and the strategic guidance that the 2020INSight plan provides, together, we can reach our shared goals.
  • A global strategy to eliminate blinding trachoma

    1. 1. Click to edit Master title style• Click to edit Master text styles – Second level • Third level – Fourth level » Fifth level A global strategy to eliminate blinding trachoma1/2/2012 1
    2. 2. Click to edit Master title style• Click to edit Master text styles – Second level • Third level – Fourth level » Fifth level We Can Eliminate Trachoma1/2/2012 2
    3. 3. What is trachoma? Click to edit Master title style• Trachoma is the leading cause of • preventable blindness worldwidestyles Click to edit Master text – – Second level poorest areas of the Mainly affects the world • Third level• Bacterial – Fourth level leads to infection that chronic eye inflammation » Fifth level – Re-infection, scarring and trauma to cornea eventually lead to blindness• Typically, children are infected at an early age and develop vision loss and blindness later in life 1/2/2012 3 2020 INSight trachomacoalition.org
    4. 4. What is trachoma? Click to edit Master title style•Every 4 minutes, 1 person experiences • Click to edit Master text stylessevere sight loss; every hour, 4 peoplebecome blind – Second level • Third level•WHO defines blinding trachoma – Fourth levelelimination as: » Fifth level – TF prevalence <5% in 1-9 year old children – TT prevalence <1 per 1000 in total population 1/2/2012 4 2020 INSight trachomacoalition.org
    5. 5. Click to edit Master title style• Click to edit Master text styles – Second level • Third level – Fourth level » Fifth levelWhat is “2020 INSight”?1/2/2012 5
    6. 6. What is “2020 INSight”? Click to edit Master title style• Outline of this strategic plan is structured around four• Click to edit Master text styles questions: – Second level  Where are we? • Third level – Fourth level  Where Fifth level » do we want to go?  How do we get there?  What is the cost of eliminating trachoma?1/2/2012 6 2020 INSight trachomacoalition.org
    7. 7. Click to edit Master title style• Click to edit Master text styles – Second level • Third level – Fourth level » Fifth levelWhere are we?1/2/2012 7
    8. 8. Where are we? Click to edit Master title style• 110 million people need treatment in confirmed endemic• areas to edit Master text styles Click – 210 million more live in areas where trachoma is suspected – Second level• Trachoma islevel • Third suspected to be endemic in 59 countries – 24% of these countries carry 80% of the burden – Fourth level• » Fifth level Using WHO-endorsed SAFE strategy to eliminate trachoma – Surgery, Antibiotics, Facial cleanliness, Environmental improvements – Progress is significant- 9 countries have achieved their UIG• Strong spirit of collaboration among trachoma control programs1/2/2012 8 2020 INSight trachomacoalition.org
    9. 9. Where are we? SAFE Strategy Click to edit Master title style• Click to edit Master text styles – Second level • Third level – Fourth level » Fifth level1/2/2012 9 2020 INSight trachomacoalition.org
    10. 10. Where are we? TrachomaCoalition.org Click to edit Master title style• Click to edit Master text styles – Second level • Third level – Fourth level » Fifth level1/2/2012 10 2020 INSight trachomacoalition.org
    11. 11. Where are we? TrachomaAtlas.org Click to edit Master title style• Click to edit Master text styles – Second level • Third level – Fourth level » Fifth level1/2/2012 11 2020 INSight trachomacoalition.org
    12. 12. Click to edit Master title style• Click to edit Master text styles – Second level • Third level – Fourth level » Fifth levelWhere do we want to go?1/2/2012 12
    13. 13. Where do we want to go? Click to edit Master for antibiotics scale-up Model for surgery scale-up Model title style• Click to edit Master text styles – Second level • Third level – Fourth level » Fifth level1/2/2012 13 2020 INSight trachomacoalition.org
    14. 14. Click to edit Master title style• Click to edit Master text styles – Second level • Third level – Fourth level » Fifth levelHow do we get there?1/2/2012 14
    15. 15. How do we get there? Click to edit Master title styleGuiding principles of elimination plan:• Click to editneed for action styles 1. Urgent Master text – Aim for – Second level fastest possible timeline in each district and focus on high-burden countries • Third level 2. Accountable ownership – Fourth level – Countries lead their own elimination process » Fifth level 3. Integration of trachoma-focused efforts – With other NTDs, Vision 2020, F & E initiatives 4. Efficient, coordinated partnerships 5. Tailored local interventions1/2/2012 15 2020 INSight trachomacoalition.org
    16. 16. How do we get there? Milestones to 2020 Click to edit Master title style Country strategy in place in sync with NTD plans -- high burden countries 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 50% 100% Planning and Funding Assessment complete -- high burden countries 50% 75% 100%• Click to edit Master text styles Country strategy in place in sync with NTD plans -- other 50% 100% Assessment complete -- other countries 50% 75% 100% – Second level % of countries with impact surveys done 50% 100% • Third level post-endemic % of countries with surveillance plan 35% 50% 100% – Fourth level » Fifth level % of surgery backlog addressed 50% 75% 100%Interventions % of population in mapped districts with A-started 50% 100% % of mapped districts with F interventions 50% 100% % of mapped districts with E interventions 50% 100%Certification % of countries having 35% 50% 100% reached UIGs in all districts % of countries having reached certification 35% 50%1/2/2012 16 2020 INSight trachomacoalition.org
    17. 17. Click to edit Master title style • Click to edit Master text styles – Second level • Third level – Fourth level » Fifth levelWhat is the cost of elimination? 1/2/2012 17
    18. 18. What is the cost of elimination? Click to edit Master title styleUSD Elimination Costs, in millions of• Economic burden of 182 trachoma  • Click to edit Master text styles $3-6 billion in annual – Second level 112 productivity loss • Third level 94 – Fourth level• Estimated cost Fifth level » of elimination  28 14 $430 million for confirmed burden 1/2/2012 18 2020 INSight trachomacoalition.org
    19. 19. Click to edit Master title style• Click to edit Master text styles – Second level The•challenge for the coming years is large, but with the Third level –incredible momentum created through our Fourth level partnerships, together, we can reach our shared goals. » Fifth level www.trachoma.orgThank You! www.trachomaatlas.org www.trachomacoalition.org1/2/2012 19 2020 INSight trachomacoalition.org

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