{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T10:46:05Z","timestamp":1774435565852,"version":"3.50.1"},"reference-count":25,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T00:00:00Z","timestamp":1738713600000},"content-version":"unspecified","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"National Institutes of Health (NIH)\u2014National Eye Institute","award":["UG1EY023939"],"award-info":[{"award-number":["UG1EY023939"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,1,16]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n<jats:title>Introduction<\/jats:title>\n<jats:p>\nTrachoma is an infectious eye disease caused by\n<jats:italic>Chlamydia trachomatis<\/jats:italic>\nand the leading infectious cause of blindness worldwide. WHO recommends community-wide oral azithromycin treatment as part of its trachoma elimination strategy. WHO initially recommended mass drug administration (MDA) with azithromycin once per year for several years, followed by reassessment. However, some districts have failed to eliminate trachoma even after a decade of annual MDA with azithromycin. As a result, WHO has recently advocated for more frequent antibiotics in districts with persistent trachoma. Although no specific frequency of antibiotic distributions has been recommended, several randomised trials have compared annual with biannual mass azithromycin distributions. This review aims to synthesise the available data to assess the effectiveness of biannual azithromycin MDA relative to annual MDA.\n<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods and analysis<\/jats:title>\n<jats:p>\nPubMed, Embase, Web of Science, Scopus and Google Scholar will be searched for studies comparing annual and biannual mass azithromycin distributions for trachoma. Community-level data will be extracted using a standardised data extraction form. Authors will be asked to contribute community-level data not available in the manuscript. The main outcome will be\n<jats:italic>C. trachomatis<\/jats:italic>\ninfection among 1\u20139-year-old children, expressed as a community-level prevalence. A secondary outcome will be the presence of trachomatous inflammation-follicular. The analysis will follow principles of a one-stage individual participant data meta-analysis using complete case mixed-effects regression models with a random effect for study to model community-level prevalence data. Statistical heterogeneity will be assessed with the\n<jats:italic>I<\/jats:italic>\n<jats:sup>2<\/jats:sup>\nstatistic.\n<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Ethics and dissemination<\/jats:title>\n<jats:p>The research will use community-aggregated data and is thus exempt from ethical approval. The results will be submitted for publication in a peer-reviewed journal.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>PROSPERO registration number<\/jats:title>\n<jats:p>CRD42024526120.<\/jats:p>\n<\/jats:sec>","DOI":"10.1136\/bmjopen-2024-087170","type":"journal-article","created":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T05:31:03Z","timestamp":1738819863000},"page":"e087170","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Annual versus biannual azithromycin mass drug administration for the elimination of infectious trachoma in Africa: protocol for a systematic review and meta-analysis using data from individual communities"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0736-2955","authenticated-orcid":false,"given":"Taye","family":"Zeru","sequence":"first","affiliation":[{"name":"Amhara Public Health Institute, Bahir Dar, Amhara, Ethiopia"},{"name":"Bahir Dar University College of Medical and Health Sciences, Bahir Dar, Amhara, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7118-1457","authenticated-orcid":false,"given":"Jeremy David","family":"Keenan","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Solomon","family":"Aragie","sequence":"additional","affiliation":[{"name":"Addis Ababa University, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Getu","family":"Degu","sequence":"additional","affiliation":[{"name":"Bahir Dar University College of Medical and Health Sciences, Bahir Dar, Amhara, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,2,6]]},"reference":[{"key":"2025070104270756000_15.2.e087170.1","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1038\/s41572-022-00359-5","article-title":"Trachoma","volume":"8","author":"Solomon","year":"2022","journal-title":"Nat Rev Dis Primers"},{"key":"2025070104270756000_15.2.e087170.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62182-0"},{"key":"2025070104270756000_15.2.e087170.3","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268899003076"},{"key":"2025070104270756000_15.2.e087170.4","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0000341","article-title":"The natural history of trachoma infection and disease in a Gambian cohort with frequent follow-up","volume":"2","author":"Grassly","year":"2008","journal-title":"PLoS Negl Trop Dis"},{"key":"2025070104270756000_15.2.e087170.5","first-page":"1887","article-title":"Trachoma control: the SAFE strategy","volume":"11","author":"Tian","year":"2018","journal-title":"Int J Ophthalmol"},{"key":"2025070104270756000_15.2.e087170.6","unstructured":"Solomon AW , World Health Organization, London School of Hygiene and Tropical Medicine . Trachoma control: a guide for programme managers. Geneva: World Health Organization, 2006."},{"key":"2025070104270756000_15.2.e087170.7","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0002415","article-title":"A randomized trial of two coverage targets for mass treatment with azithromycin for trachoma","volume":"7","author":"West","year":"2013","journal-title":"PLoS Negl Trop Dis"},{"key":"2025070104270756000_15.2.e087170.8","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1093\/cid\/ciw810","article-title":"A Cluster-Randomized Trial to Assess the Efficacy of Targeting Trachoma Treatment to Children","volume":"64","author":"Amza","year":"2017","journal-title":"Clin Infect Dis"},{"key":"2025070104270756000_15.2.e087170.9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.299.7.778"},{"key":"2025070104270756000_15.2.e087170.10","unstructured":"World Health Organization . Informal consultation on end-game challenges for trachoma elimination, task force for global health, decatur, United States of America, 7\u20139 December 2021. 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