{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T06:00:19Z","timestamp":1772604019336,"version":"3.50.1"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T00:00:00Z","timestamp":1614556800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U10EY023939"],"award-info":[{"award-number":["U10EY023939"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Current guidelines recommend community-wide mass azithromycin for trachoma, but a targeted treatment strategy could reduce the volume of antibiotics required.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In total, 48 Ethiopian communities were randomized to mass, targeted, or delayed azithromycin distributions. In the targeted arm, only children aged 6 months to 5 years with evidence of ocular chlamydia received azithromycin, distributed thrice over the following year. The primary outcome was ocular chlamydia at months 12 and 24, comparing the targeted and delayed arms (0\u20135 year-olds, superiority analysis) and the targeted and mass azithromycin arms (8\u201312 year-olds, noninferiority analysis, 10% noninferiority margin).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>At baseline, the mean prevalence of ocular chlamydia in the 3 arms ranged from 7% to 9% among 0\u20135 year-olds and from 3% to 9% among 8\u201312 year-olds. Averaged across months 12\u201324, the mean prevalence of ocular chlamydia among 0\u20135 year-olds was 16.7% (95% confidence interval [CI]: 9.0%\u201324.4%) in the targeted arm and 22.3% (95% CI: 11.1%\u201333.6%) in the delayed arm (P\u2005=\u2005.61). The final mean prevalence of ocular chlamydia among 8\u201312 year-olds was 13.5% (95% CI: 7.9%\u201319.1%) in the targeted arm and 5.5% (95% CI: 0.3%\u201310.7%) in the mass treatment arm (adjusted risk difference 8.5 percentage points [pp] higher in the targeted arm, 95% CI: 0.9 pp\u201316.1 pp higher).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Antibiotic treatments targeted to infected preschool children did not result in significantly less ocular chlamydia infections compared with untreated communities and did not meet noninferiority criteria relative to mass azithromycin distributions. Targeted approaches may require treatment of a broader segment of the population in areas with hyperendemic trachoma.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciab193","type":"journal-article","created":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T20:12:44Z","timestamp":1614283964000},"page":"979-986","source":"Crossref","is-referenced-by-count":9,"title":["Targeted Antibiotics for Trachoma: A Cluster-Randomized Trial"],"prefix":"10.1093","volume":"73","author":[{"given":"Jason S","family":"Melo","sequence":"first","affiliation":[{"name":"Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Solomon","family":"Aragie","sequence":"additional","affiliation":[{"name":"The Carter Center Ethiopia, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ambahun","family":"Chernet","sequence":"additional","affiliation":[{"name":"The Carter Center Ethiopia, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zerihun","family":"Tadesse","sequence":"additional","affiliation":[{"name":"The Carter Center Ethiopia, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adane","family":"Dagnew","sequence":"additional","affiliation":[{"name":"The Carter Center Ethiopia, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dagnachew","family":"Hailu","sequence":"additional","affiliation":[{"name":"The Carter Center Ethiopia, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahteme","family":"Haile","sequence":"additional","affiliation":[{"name":"Amhara Public Health Institute, Bahir Dar, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T\u00e0ye","family":"Zeru","sequence":"additional","affiliation":[{"name":"Amhara Public Health Institute, Bahir Dar, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dionna M","family":"Wittberg","sequence":"additional","affiliation":[{"name":"Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott D","family":"Nash","sequence":"additional","affiliation":[{"name":"The Carter Center, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E Kelly","family":"Callahan","sequence":"additional","affiliation":[{"name":"The Carter Center, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin F","family":"Arnold","sequence":"additional","affiliation":[{"name":"Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA"},{"name":"Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Travis C","family":"Porco","sequence":"additional","affiliation":[{"name":"Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA"},{"name":"Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA"},{"name":"Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas M","family":"Lietman","sequence":"additional","affiliation":[{"name":"Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA"},{"name":"Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA"},{"name":"Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA"},{"name":"Institute for Global Health, University of California San Francisco, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy D","family":"Keenan","sequence":"additional","affiliation":[{"name":"Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA"},{"name":"Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,3,1]]},"reference":[{"key":"2021091515522791200_CIT0001","volume-title":"Trachoma control: a guide for programme managers","author":"Solomon","year":"2006"},{"key":"2021091515522791200_CIT0002","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1017\/S0950268899003076","article-title":"The duration of human ocular Chlamydia trachomatis infection is age dependent","volume":"123","author":"Bailey","year":"1999","journal-title":"Epidemiol Infect"},{"key":"2021091515522791200_CIT0003","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/S0140-6736(03)13909-8","article-title":"Strategies for control of trachoma: observational study with quantitative PCR","volume":"362","author":"Solomon","year":"2003","journal-title":"Lancet"},{"key":"2021091515522791200_CIT0004","doi-asserted-by":"crossref","first-page":"1962","DOI":"10.1056\/NEJMoa040979","article-title":"Mass treatment with single-dose azithromycin for trachoma","volume":"351","author":"Solomon","year":"2004","journal-title":"N Engl J Med"},{"key":"2021091515522791200_CIT0005","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1167\/iovs.04-0327","article-title":"Mass treatment and the effect on the load of Chlamydia trachomatis infection in a trachoma-hyperendemic community","volume":"46","author":"West","year":"2005","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"2021091515522791200_CIT0006","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1016\/S0140-6736(05)61029-X","article-title":"Re-emergence of Chlamydia trachomatis infection after mass antibiotic treatment of a trachoma-endemic Gambian community: a longitudinal study","volume":"365","author":"Burton","year":"2005","journal-title":"Lancet"},{"key":"2021091515522791200_CIT0007","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1038\/8451","article-title":"Global elimination of trachoma: how frequently should we administer mass chemotherapy?","volume":"5","author":"Lietman","year":"1999","journal-title":"Nat Med"},{"key":"2021091515522791200_CIT0008","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1016\/S0140-6736(09)60323-8","article-title":"Assessment of herd protection against trachoma due to repeated mass antibiotic distributions: a cluster-randomised trial","volume":"373","author":"House","year":"2009","journal-title":"Lancet"},{"key":"2021091515522791200_CIT0009","first-page":"201","article-title":"Cost-effectiveness of trachoma control measures: comparing targeted household treatment and mass treatment of children","volume":"79","author":"Frick","year":"2001","journal-title":"Bull World Health Organ"},{"key":"2021091515522791200_CIT0010","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.actatropica.2006.12.003","article-title":"Longitudinal evaluation of three azithromycin distribution strategies for treatment of trachoma in a sub-Saharan African country, Mali","volume":"101","author":"Sch\u00e9mann","year":"2007","journal-title":"Acta Trop"},{"key":"2021091515522791200_CIT0011","doi-asserted-by":"crossref","first-page":"163","DOI":"10.5694\/j.1326-5377.2000.tb125541.x","article-title":"A targeted, single-dose azithromycin strategy for trachoma","volume":"172","author":"Laming","year":"2000","journal-title":"Med J Aust"},{"key":"2021091515522791200_CIT0012","first-page":"194","article-title":"Comparison of two azithromycin distribution strategies for controlling trachoma in Nepal","volume":"79","author":"Holm","year":"2001","journal-title":"Bull World Health Organ"},{"key":"2021091515522791200_CIT0013","doi-asserted-by":"crossref","first-page":"1488","DOI":"10.1001\/jama.296.12.1488","article-title":"Impact of annual targeted treatment on infectious trachoma and susceptibility to reinfection","volume":"296","author":"Atik","year":"2006","journal-title":"JAMA"},{"key":"2021091515522791200_CIT0014","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1093\/ije\/dyx039","article-title":"Spillover effects on health outcomes in low- and middle-income countries: a systematic review","volume":"46","author":"Benjamin-Chung","year":"2017","journal-title":"Int J Epidemiol"},{"key":"2021091515522791200_CIT0015","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1093\/ije\/dyx201","article-title":"Spillover effects in epidemiology: parameters, study designs and methodological considerations","volume":"47","author":"Benjamin-Chung","year":"2018","journal-title":"Int J Epidemiol"},{"key":"2021091515522791200_CIT0016","doi-asserted-by":"crossref","first-page":"e039529","DOI":"10.1136\/bmjopen-2020-039529","article-title":"WASH Upgrades for Health in Amhara (WUHA): study protocol for a cluster-randomised trial in Ethiopia","volume":"11","author":"Wittberg","year":"2021","journal-title":"BMJ Open"},{"key":"2021091515522791200_CIT0017","doi-asserted-by":"crossref","first-page":"570898","DOI":"10.1155\/2015\/570898","article-title":"Prevalence of active trachoma and its associated factors among rural and urban children in Dera woreda, northwest Ethiopia: a comparative cross-sectional study","volume":"2015","author":"Alemayehu","year":"2015","journal-title":"Biomed Res Int"},{"key":"2021091515522791200_CIT0018","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.4269\/ajtmh.19-0450","article-title":"Progress to eliminate trachoma as a public health problem in Amhara national regional state, Ethiopia: results of 152 population-based surveys","volume":"101","author":"Stewart","year":"2019","journal-title":"Am J Trop Med Hyg"},{"key":"2021091515522791200_CIT0019","doi-asserted-by":"crossref","first-page":"e0008226","DOI":"10.1371\/journal.pntd.0008226","article-title":"Ocular Chlamydia trachomatis infection and infectious load among pre-school aged children within trachoma hyperendemic districts receiving the SAFE strategy, Amhara region, Ethiopia","volume":"14","author":"Nash","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"key":"2021091515522791200_CIT0020","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.inhe.2011.03.004","article-title":"Efficacy of latrine promotion on emergence of infection with ocular Chlamydia trachomatis after mass antibiotic treatment: a cluster-randomized trial","volume":"3","author":"Stoller","year":"2011","journal-title":"Int Health"},{"key":"2021091515522791200_CIT0021","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/S0140-6736(11)61515-8","article-title":"Comparison of annual versus twice-yearly mass azithromycin treatment for hyperendemic trachoma in Ethiopia: a cluster-randomised trial","volume":"379","author":"Gebre","year":"2012","journal-title":"Lancet"},{"key":"2021091515522791200_CIT0022","doi-asserted-by":"crossref","first-page":"e1002633","DOI":"10.1371\/journal.pmed.1002633","article-title":"Mass azithromycin distribution for hyperendemic trachoma following a cluster-randomized trial: a continuation study of randomly reassigned subclusters (TANA II)","volume":"15","author":"Keenan","year":"2018","journal-title":"PLoS Med"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciab193\/37533026\/ciab193.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/73\/6\/979\/40392501\/ciab193.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/73\/6\/979\/40392501\/ciab193.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,15]],"date-time":"2021-09-15T16:21:05Z","timestamp":1631722865000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/73\/6\/979\/6155670"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,1]]},"references-count":22,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,3,1]]},"published-print":{"date-parts":[[2021,9,15]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciab193","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,9,15]]},"published":{"date-parts":[[2021,3,1]]}}}