{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T06:28:03Z","timestamp":1792218483851,"version":"4.4.0"},"reference-count":32,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3_Suppl","license":[{"start":{"date-parts":[[2024,9,3]],"date-time":"2024-09-03T00:00:00Z","timestamp":1725321600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,9,3]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Persistent trachoma is a growing concern to trachoma control programs globally and programs serving Ethiopia specifically. Persistent trachoma is defined as a district with two or more trachoma impact surveys (TISs) at which the prevalence of trachomatous inflammation-follicular (TF) among children ages 1\u20139\u2009years is \u22655%, the elimination threshold. Because the global target for trachoma elimination as a public health problem is 2030, research is needed to better characterize persistent trachoma. This study described the epidemiology of ocular <jats:italic>Chlamydia trachomatis<\/jats:italic> infection, the causative bacteria of trachoma, in seven contiguous districts experiencing persistent trachoma. In 2019, multistage cluster random sampling TISs were conducted in the seven districts after 10\u2009years of interventions. All individuals ages \u22651\u2009year were examined for trachoma clinical signs by certified graders, and conjunctival swabs were collected from children ages 1\u20135\u2009years to test for <jats:italic>C. trachomatis<\/jats:italic> infection. The district TF prevalence ranged from 11.8% (95% CI:7.6\u201316.0%) to 36.1% (95% CI:27.4<jats:italic>\u2013<\/jats:italic>44.3%). The range of district-level <jats:italic>C. trachomatis<\/jats:italic> infection prevalence was between 2.7% and 34.4%. Statistically significant spatial clustering of high<jats:italic>-<\/jats:italic>infection communities was observed in the study districts, and children with infection were more likely than those without to be found in households with clinical signs of trachoma and those without latrines. These seven districts appear to constitute a persistent hotspot in Amhara, where an additional 3<jats:italic>\u2013<\/jats:italic>5\u2009years or more of interventions will be required. The global program will need to strengthen and enhance intervention strategies within persistent districts if elimination by 2030 is to be achieved.<\/jats:p>","DOI":"10.4269\/ajtmh.23-0876","type":"journal-article","created":{"date-parts":[[2024,7,2]],"date-time":"2024-07-02T13:18:32Z","timestamp":1719926312000},"page":"105-113","source":"Crossref","is-referenced-by-count":9,"title":["The Epidemiology of Ocular Chlamydia trachomatis Infection within Districts Persistently Endemic for Trachoma in Amhara, Ethiopia"],"prefix":"10.4269","volume":"111","author":[{"given":"Scott D.","family":"Nash","sequence":"first","affiliation":[{"name":"The Carter Center, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eshetu","family":"Sata","sequence":"additional","affiliation":[{"name":"The Carter Center, Addis Ababa, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ambahun","family":"Chernet","sequence":"additional","affiliation":[{"name":"The Carter Center, Addis Ababa, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania A.","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"The Carter Center, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew W.","family":"Nute","sequence":"additional","affiliation":[{"name":"The Carter Center, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria C.","family":"Ontiveros","sequence":"additional","affiliation":[{"name":"The Carter Center, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Demelash","family":"Gessese","sequence":"additional","affiliation":[{"name":"The Carter Center, Addis Ababa, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mulat","family":"Zerihun","sequence":"additional","affiliation":[{"name":"The Carter Center, Addis Ababa, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly A.","family":"Jensen","sequence":"additional","affiliation":[{"name":"The Carter Center, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gizachew","family":"Yismaw","sequence":"additional","affiliation":[{"name":"Amhara Public Health Institute, Bahir Dar, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taye","family":"Zeru","sequence":"additional","affiliation":[{"name":"Amhara Public Health Institute, Bahir Dar, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berhanu","family":"Melak","sequence":"additional","affiliation":[{"name":"The Carter Center, Addis Ababa, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zebene","family":"Ayele","sequence":"additional","affiliation":[{"name":"The Carter Center, Addis Ababa, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fetene","family":"Mihretu","sequence":"additional","affiliation":[{"name":"The Carter Center, Addis Ababa, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fikre","family":"Seife","sequence":"additional","affiliation":[{"name":"Federal Ministry of Health, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zerihun","family":"Tadesse","sequence":"additional","affiliation":[{"name":"The Carter Center, Addis Ababa, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. Kelly","family":"Callahan","sequence":"additional","affiliation":[{"name":"The Carter Center, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Wkly Epidemiol Rec","first-page":"297","article-title":"WHO Alliance for the Global Elimination of Trachoma: Progress report on elimination of trachoma, 2022","volume":"98","year":"2023"},{"key":"b2","series-title":"National Survey on Blindness, Low Vision and Trachoma in Ethiopia","author":"Berhane","year":"2006"},{"key":"b3","series-title":"PLoS Negl Trop Dis","first-page":"e197","article-title":"Integrating an NTD with one of \u201cthe big three\u201d: Combined malaria and trachoma survey in Amhara region of Ethiopia","volume":"2","author":"Emerson","year":"2008"},{"key":"b4","series-title":"Trans R Soc Trop Med Hyg","first-page":"1001","article-title":"Evaluation of three years of the SAFE strategy (Surgery, Antibiotics, Facial cleanliness and Environmental improvement) for trachoma control in five districts of Ethiopia hyperendemic for trachoma","volume":"103","author":"Ngondi","year":"2009"},{"key":"b5","series-title":"Am J Trop Med Hyg","first-page":"1278","article-title":"Twelve-year longitudinal trends in trachoma prevalence among children aged 1\u20139 years in Amhara, Ethiopia, 2007\u20132019","volume":"104","author":"Sata","year":"2021"},{"key":"b6","series-title":"Informal Consultation on End-Game Challenges for Trachoma Elimination, Task Force for Global Health, Decatur, United States of America, 7\u20139 December 2021","year":"2022"},{"key":"b7","series-title":"Am J Trop Med Hyg","first-page":"207","article-title":"Population-based prevalence of Chlamydia trachomatis infection and antibodies in four districts with varying levels of trachoma endemicity in Amhara, Ethiopia","volume":"104","author":"Nash","year":"2021"},{"key":"b8","series-title":"Trans R Soc Trop Med Hyg","first-page":"213","article-title":"Modelling trachoma post 2020: Opportunities for mitigating the impact of COVID-19 and accelerating progress towards elimination","volume":"115","author":"Borlase","year":"2020"},{"key":"b9","series-title":"Am J Trop Med Hyg","first-page":"1189","article-title":"One size does not fit all: Achieving trachoma control by 2030","volume":"101","author":"Oldenburg","year":"2019"},{"key":"b10","series-title":"Clin Infect Dis","first-page":"1840","article-title":"Ocular Chlamydia trachomatis infection under the Surgery, Antibiotics, Facial Cleanliness, and Environmental Improvement Strategy in Amhara, Ethiopia, 2011\u20132015","volume":"67","author":"Nash","year":"2018"},{"key":"b11","series-title":"Am J Trop Med Hyg","first-page":"261","article-title":"Prevalence of ocular Chlamydia trachomatis infection in Amhara region, Ethiopia, after 8 years of trachoma control interventions","volume":"108","author":"Nash","year":"2023"},{"key":"b12","series-title":"PLoS Negl Trop Dis","first-page":"e0006270","article-title":"Population-based coverage survey results following the mass drug administration of azithromycin for the treatment of trachoma in Amhara, Ethiopia","volume":"12","author":"Astale","year":"2018"},{"key":"b13","series-title":"Trop Med Int Health","first-page":"493","article-title":"Population coverage and factors associated with participation following a mass drug administration of azithromycin for trachoma elimination in Amhara, Ethiopia","volume":"24","author":"Ebert","year":"2019"},{"key":"b14","series-title":"Am J Trop Med Hyg","first-page":"1286","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"},{"key":"b15","series-title":"Ophthalmic Epidemiol","first-page":"214","article-title":"The Global Trachoma Mapping Project: Methodology of a 34-country population-based study","volume":"22","author":"Solomon","year":"2015"},{"key":"b16","series-title":"Bull World Health Organ","first-page":"477","article-title":"A simple system for the assessment of trachoma and its complications","volume":"65","author":"Thylefors","year":"1987"},{"key":"b17","series-title":"Joint Monitoring Programme for Water Supply, Sanitation and Hygiene. 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Conjunctival Chlamydia trachomatis infection load in Gambian villages","volume":"44","author":"Burton","year":"2003"},{"key":"b26","series-title":"Invest Ophthalmol Vis Sci","first-page":"83","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"},{"key":"b27","series-title":"Parasit Vectors","first-page":"624","article-title":"The impact of a single round of community mass treatment with azithromycin on disease severity and ocular Chlamydia trachomatis load in treatment-naive trachoma-endemic island communities in West Africa","volume":"10","author":"Last","year":"2017"},{"key":"b28","series-title":"Trans R Soc Trop Med Hyg","first-page":"175","article-title":"An index of community ocular Chlamydia trachomatis load for control of trachoma","volume":"99","author":"Alexander","year":"2005"},{"key":"b29","series-title":"Trans R Soc Trop Med Hyg","first-page":"28","article-title":"Transmission ecology of the fly Musca sorbens, a putative vector of trachoma","volume":"94","author":"Emerson","year":"2000"},{"key":"b30","series-title":"Bull World Health Organ","first-page":"250","article-title":"Active trachoma and community use of sanitation, Ethiopia","volume":"95","author":"Oswald","year":"2017"},{"key":"b31","series-title":"Trop Med Int Health","first-page":"592","article-title":"Effect of a community intervention with pit latrines in five districts of Amhara, Ethiopia","volume":"15","author":"Ngondi","year":"2010"},{"key":"b32","series-title":"Parasit Vectors","first-page":"540","article-title":"Associations between Water, Sanitation and Hygiene (WASH) and trachoma clustering at aggregate spatial scales, Amhara, Ethiopia","volume":"12","author":"Altherr","year":"2019"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/111\/3_Suppl\/article-p105.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/111\/3_Suppl\/article-p105.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/111\/3_Suppl\/article-p105.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,4]],"date-time":"2024-09-04T19:54:08Z","timestamp":1725479648000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/111\/3_Suppl\/article-p105.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,3]]},"references-count":32,"journal-issue":{"issue":"3_Suppl"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.23-0876","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,3]]}}}