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A global strategy to eliminate blinding trachoma
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A global strategy to eliminate blinding trachoma
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We Can Eliminate Trachoma
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3. What is trachoma?
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• Trachoma is the leading cause of
• preventable blindness worldwidestyles
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– – Second level poorest areas of the
Mainly affects the
world
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• Bacterial – Fourth level leads to
infection that
chronic eye inflammation
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– 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
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2020 INSight trachomacoalition.org
4. What is trachoma?
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•Every 4 minutes, 1 person experiences
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severe sight loss; every hour, 4 people
become blind
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•WHO defines blinding trachoma
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elimination as:
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– TF prevalence <5% in 1-9 year old
children
– TT prevalence <1 per 1000 in
total population
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2020 INSight trachomacoalition.org
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What is “2020 INSight”?
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6. What is “2020 INSight”?
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• Outline of this strategic plan is structured around four
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questions:
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Where are we?
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Where Fifth level
» do we want to go?
How do we get there?
What is the cost of eliminating trachoma?
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2020 INSight trachomacoalition.org
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Where are we?
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8. Where are we?
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• 110 million people need treatment in confirmed endemic
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– 210 million more live in areas where trachoma is suspected
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• Trachoma islevel
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suspected to be endemic in 59 countries
– 24% of these countries carry 80% of the burden
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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
programs
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2020 INSight trachomacoalition.org
9. Where are we? SAFE Strategy
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2020 INSight trachomacoalition.org
10. Where are we? TrachomaCoalition.org
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11. Where are we? TrachomaAtlas.org
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Where do we want to go?
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13. Where do we want to go?
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Model for surgery scale-up
Model
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2020 INSight trachomacoalition.org
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How do we get there?
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15. How do we get there?
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Guiding principles of elimination plan:
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1. Urgent Master text
– Aim for
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focus on high-burden countries
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2. Accountable ownership
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– Countries lead their own elimination process
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3. Integration of trachoma-focused efforts
– With other NTDs, Vision 2020, F & E initiatives
4. Efficient, coordinated partnerships
5. Tailored local interventions
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2020 INSight trachomacoalition.org
16. How do we get there? Milestones to 2020
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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%
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with NTD plans -- other
50% 100%
Assessment complete -- other countries 50% 75% 100%
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% of countries with impact surveys done 50% 100%
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% of countries with
surveillance plan
35% 50% 100%
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% 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
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reached UIGs in all districts
% of countries having reached certification 35% 50%
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2020 INSight trachomacoalition.org
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What is the cost of elimination?
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18. What is the cost of elimination?
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Elimination Costs, in millions of
• Economic burden of 182
trachoma
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$3-6 billion in annual
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productivity loss
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• Estimated cost Fifth level
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elimination 28
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$430 million for
confirmed burden
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2020 INSight trachomacoalition.org
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The•challenge for the coming years is large, but with the
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–incredible momentum created through our
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partnerships, together, we can reach our shared goals.
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www.trachoma.org
Thank You! www.trachomaatlas.org
www.trachomacoalition.org
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Editor's Notes
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.
