{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T06:29:20Z","timestamp":1792218560201,"version":"4.4.0"},"reference-count":287,"publisher":"American Society of Tropical Medicine and Hygiene","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"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":[[2026,9,22]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Field-graded trachomatous inflammation\u2013follicular (TF) has limitations as the sole indicator of\n                    <jats:italic>Chlamydia trachomatis<\/jats:italic>\n                    (\n                    <jats:italic>Ct<\/jats:italic>\n                    ) transmission for trachoma programmatic decision-making. To assess the relationship between field-graded TF and other methodologies for evaluating\n                    <jats:italic>Ct<\/jats:italic>\n                    transmission intensity, a systematic review was conducted. A total of 35,764 studies were screened, yielding 235 included studies from 49 countries spanning the years of data collection from 1991 to 2021 and the years of publication from 1991 to 2022. The relationship between TF and other indicators was stronger before mass drug administration (MDA) versus after MDA initiation: TF versus infection (\n                    <jats:italic>R<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    = 0.43,\n                    <jats:italic>P<\/jats:italic>\n                    = 0.004 versus\n                    <jats:italic>R<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    = 0.05,\n                    <jats:italic>P<\/jats:italic>\n                    = 0.140, respectively), TF versus seroprevalence (\n                    <jats:italic>R<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    = 0.55,\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.001 versus\n                    <jats:italic>R<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    = 0.09,\n                    <jats:italic>P<\/jats:italic>\n                    = 0.084, respectively), and TF versus seroconversion rate (SCR;\n                    <jats:italic>R<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    = 0.52,\n                    <jats:italic>P<\/jats:italic>\n                    = 0.012 versus\n                    <jats:italic>R<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    = 0.26,\n                    <jats:italic>P<\/jats:italic>\n                    = 0.061, respectively). Post-MDA initiation, infection and SCR were highly correlated (\n                    <jats:italic>R<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    = 0.71,\n                    <jats:italic>P<\/jats:italic>\n                    = 0.001). These results are strongly suggestive of the poor performance of TF prevalence for guiding programmatic decision-making post-MDA initiation. Infection and\/or serology should be considered in these settings.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0541","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T15:29:08Z","timestamp":1790090948000},"source":"Crossref","is-referenced-by-count":1,"title":["Comparison of Methods for Assessing Chlamydia trachomatis Transmission Intensity: A Systematic Review"],"prefix":"10.4269","author":[{"given":"Kristen K.","family":"Renneker","sequence":"first","affiliation":[{"name":"International Trachoma Initiative, Task Force for Global Health, Decatur, Georgia, USA;"},{"name":"Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Che-Chi","family":"Lin","sequence":"additional","affiliation":[{"name":"International Trachoma Initiative, Task Force for Global Health, Decatur, Georgia, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela J.","family":"Hooper","sequence":"additional","affiliation":[{"name":"International Trachoma Initiative, Task Force for Global Health, Decatur, Georgia, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Butcher","sequence":"additional","affiliation":[{"name":"Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. D\u00e9irdre","family":"Hollingsworth","sequence":"additional","affiliation":[{"name":"Big Data Institute, La Ka Shing Center for Health Informatics, University of Oxford, Oxford, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana L.","family":"Martin","sequence":"additional","affiliation":[{"name":"Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony W.","family":"Solomon","sequence":"additional","affiliation":[{"name":"Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma M.","family":"Harding-Esch","sequence":"additional","affiliation":[{"name":"Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"issue":"1","key":"b1","series-title":"Nat Rev Dis Primers","first-page":"32","article-title":"Trachoma","volume":"8","author":"Solomon","year":"2022"},{"key":"b2","article-title":"Fourth WHO Scientific Group on Trachoma Research [Meeting Held in Geneva from 9 to 14 August 1965]: Report.","year":"1966"},{"key":"b3","series-title":"Guide to Trachoma Control in Programmes for the Prevention of Blindness","author":"Dawson","year":"1981"},{"issue":"4","key":"b4","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"},{"issue":"6","key":"b5","series-title":"Ophthalmic Epidemiol","first-page":"544","article-title":"Tropical data: Approach and methodology as applied to trachoma prevalence 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