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No data exist on how long countries must have dedicated TT programs, as the timeline for progression to TT from trachomatous scarring is unknown. We used eight years of longitudinal data in women in Kongwa Tanzania to model progression from no scarring (S0) through grades of scarring severity (S1\u2013S4) to TT. Markov models were used, with age, community prevalence of TF (CPTF), and household characteristics as co-variates. Adjusted for covariates, the incidence of S1 was estimated at 4\u22197% per year, and the risk increased by 26% if the CPTF was between 5\u201310% and by 48% if greater than 10%. The transition from S4 to TT was estimated at 2\u22196% per year. Districts, even after elimination of TF, may have some communities with TF\u2009\u2265\u20095% and increased risk of incident scarring. Once scarring progresses to S2, further progression is not dependent on CPTF. These data suggest that, depending on the district level of scarring and degree of heterogeneity in CPTF at the time of elimination, incident TT will still be an issue for decades.<\/jats:p>","DOI":"10.1038\/s41598-024-67245-w","type":"journal-article","created":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T06:02:04Z","timestamp":1721368924000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Model of yearly transition to severe trachomatous scarring and trichiasis in a cohort of women in Kongwa Tanzania"],"prefix":"10.1038","volume":"14","author":[{"given":"Sheila K.","family":"West","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley","family":"Hazel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatriz","family":"Munoz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meraf A.","family":"Wolle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harran","family":"Mkocha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Travis C.","family":"Porco","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,7,19]]},"reference":[{"key":"67245_CR1","unstructured":"WHO Alliance for the Global Elimination of Trachoma: progress report on elimination of trachoma, 2022. 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M., Derrick, T., Holland, M. J. & Burton, M. J. Blinding trachoma: Systematic review of rates and risk factors for progressive disease. PLoS Negl. Trop. Dis. 10(8), e0004859. https:\/\/doi.org\/10.1371\/journal.pntd.0004859 (2016).","journal-title":"PLoS Negl. Trop. Dis."},{"issue":"10","key":"67245_CR5","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0008708","volume":"14","author":"MS Kashaf","year":"2020","unstructured":"Kashaf, M. S. et al. Incidence and progression of trachomatous scarring in a cohort of children in a formerly hyper-endemic district of Tanzania. PLoS Negl. Trop. Dis. 14(10), e0008708. https:\/\/doi.org\/10.1371\/journal.pntd.0008708 (2020).","journal-title":"PLoS Negl. Trop. Dis."},{"key":"67245_CR6","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1167\/iovs.08-2414","volume":"50","author":"MA Wolle","year":"2009","unstructured":"Wolle, M. A., Mu\u00f1oz, B. E., Mkocha, H. & West, S. K. Age, sex, and cohort effects in a longitudinal study of trachomatous scarring. Investig. Ophthalmol. Vis. Sci. 50, 592\u2013596. https:\/\/doi.org\/10.1167\/iovs.08-2414 (2009).","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"issue":"Supplement_2","key":"67245_CR7","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1093\/inthealth\/ihad078","volume":"15","author":"Y Nayel","year":"2023","unstructured":"Nayel, Y., Mu\u00f1oz, B. E., Mkocha, H., West, S. K. & Wolle, M. A. Expanding a photographic grading system for trachomatous scarring. Int. Health. 15(Supplement_2), 25\u201329 (2023).","journal-title":"Int. Health."},{"key":"67245_CR8","doi-asserted-by":"publisher","first-page":"3249","DOI":"10.1167\/iovs.17-21519","volume":"58","author":"JT Cox","year":"2017","unstructured":"Cox, J. T. et al. Trachomatous scarring and infection with non-chlamydia trachomatis bacteria in women in Kongwa, Tanzania. Investig. Ophthalmol. Vis. 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