Trichiasis Clinical Trial
Official title:
Identification of TT Cases by Community Treatment Assistants: An Assessment
To achieve the goal of trachoma control as mandated by the World Health Organization,
countries must reduce the backlog of trichiasis surgery cases to less than 1/1,000 of their
population. However, these cases reside in rural villages in trachoma endemic districts, and
finding them to offer services is a challenge. Community Treatment Assistants (CTAs) are
village residents who are trained to offer Mass Drug Administration (MDA) to their
communities and hence are in contact with most residents. A training guide and tool for
screening for trachomatous trichiasis (TT) will be developed to train CTAs in rural Tanzania
to identify cases in their communities and refer them to surgery. Compared to the current
process by which CTAs passively screen for TT if cases complaint, investigators hypothesize
that the trained CTAs will identify twice the usual number of TT surgery cases during ongoing
community antibiotic administrations for trachoma and will also miss fewer cases. If this
simple system is effective, it can be implemented widely to screen communities for cases of
TT.
Residents from thirty-six villages holding MDA, for whom a complete census is available, will
be randomized on a 1:1 basis to intervention (where the CTAs receive the enhanced training
from the enhanced training team) and usual assessment (where the CTAs receive the usual
instructions from the regular MDA team). In both arms, the CTAs will keep records of all
cases they have screened as positive for TT amongst the residents.
A Master TT grader will grade all screened cases of TT to determine the rate of true
positivity in both arms.In addition, he will examine a random sample of residents who are
screened as negative to detect potentially missed cases and estimate the total burden of
trichiasis cases in both arms as well.The assessments of the Master TT grader will serve as
the gold standard for calculations of sensitivity, specificity, and positive and negative
predictive values of the enhanced training versus usual assessment methods.
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