This study intends to improve our understanding of the effects of mass antibiotic distributions for trachoma by conducting an in depth analysis of populations in which trachoma has ostensibly been eliminated and by assessing the positive secondary effects of mass antibiotic treatments on childhood morbidity and mortality. It benefits from the infrastructure of two clinical trials: TANA (Trachoma Amelioration in Northern Amhara) and PRET (Partnership for the Rapid Elimination of Trachoma, Gates Foundation). The WHO launched the GET 2020 (Global Elimination of Trachoma by the year 2020) program to eliminate blinding trachoma, however, the goals have not been met, particularly in hyperendemic communities. Mass treatments have been used in several elimination campaigns and have been found to have unintended secondary effects. Specific aims: SA1: To determine if C. trachomatis infection can be eliminated using rRNA-based nucleic acid amplification compared to DNA-based testing. SA2a: To determine if azithromycin treatments reduce mortality in 1-5 year olds from diarrhea, respiratory disease and malaria. SA2b: To determine if azithromycin treatments effect increases in height, weight, and arm circumference. The goal is to determine if complete elimination is attainable in hyperendemic communities and then to translate these research findings quickly into practice within trachoma programs in general and within the WHO GET 2020 program in particular. Growth indices are a common method for determining the efficacy of mass treatment; developing and testing an instrument for measuring growth and nutrition will provide an important bridge to future studies on integration of trachoma with other neglected tropical diseases (NTD).

Public Health Relevance: The goal of this project is to improve our understanding of mass antibiotic distributions for trachoma, assessing populations in which trachoma was presumably eliminated, and evaluating for secondary effects of these mass treatments. This is critical for establishing both the efficacy and safety of the WHO Global Elimination of Trachoma campaign.