Fifth Regional Meeting of Managers of National Programs for the Elimination of Trachoma as a Public Health Problem in the Americas Lima, August 1-3 2018 Report 1 Fifth Regional Meeting of Managers of National Programs for the Elimination of Trachoma as a Public Health Problem in the Americas Lima, August 1-3, 2018 Report Washington, D.C. 2019 p Also published in Spanish and Portuguese Quinta Reunión de Gerentes de los Programas Nacionales para la Eliminación del Tracoma como Problema de Salud Pública de las Américas. (Lima, 1 al 3 de agosto de 2018). OPS/CDE/19-011 Quinta reunião de gestores dos programas nacionais para a eliminação do tracoma como problema de saúde pública das Américas. (Lima, 1 a 3 de agosto de 2018). OPAS/CDE/19-011 Fifth Regional Meeting of Managers of National Programs for the Elimination of Trachoma as a Public Health Problem in the Americas. (Lima, August 1-3 2018) PAHO/CDE/19-011 © Pan American Health Organization 2019 All rights reserved. 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In no event shall PAHO be liable for damages arising from its use CONTENTS Acronyms .............................................................................................................................................................5 Glossary...............................................................................................................................................................6 Summary .............................................................................................................................................................7 1. Progress toward the elimination of the trachoma as a public health problem ............................. 11 1.1. Progress at the global and regional levels ............................................................................... 11 1.2. Specific progress and challenges by country in the Region of the Americas .........................14 1.2.1. Countries where trachoma is a public health problem ...........................................................14 1.2.2. Countries that are not recognized endemic for trachoma ......................................................18 1.2.3. Countries in the post-elimination surveillance phase ������������������������������������������������������������ 21 2. Innovative tools for trachoma elimination ........................................................................................23 2.1. Proposal for the identification of areas for trachoma mapping in the Region of the Americas ............................................................................................................23 2.2. New technologies grading trachoma with an image capture and processing system ...........25 2.3. New technology for training trachoma graders in the recognition of trachomatous trichiasis .......................................................................................................26 2.4. Human Eyelid Analog Device for Surgical Training and Skills Reinforcement in Trachoma (HEAD START) ...................................................................................................... 27 3 2.5. Tropical Data Initiative: innovation in the development, implementation, and data analysis of trachoma surveys .....................................................................................28 2.6. Multiplex initiative and serology for post-elimination surveillance of trachoma ..................29 2.7. Support for evaluationg follicle size when grading trachomatous inflammation-follicular ......................................................................................29 2.8. Surveys for trachomatous trichiasis ����������������������������������������������������������������������������������������� 31 3. Surgery for people with trachomatous trichiasis: experiences in the Region of the Americas ...............................................................................................33 3.1. Experience of Colombia during integrated surgery campaigns for trachomatous and other visual impairment problems .....................................................................................................33 3.2. Brazil's experience with surgery for trachomatous trichiasis in indigenous communities .......................................................................................................33 3.3. Experience of Guatemala with surgery for trachomatous trichiasis in indigenous communities .......................................................................................................34 4. Proposed Regional Plan to Accelerate Trachoma Elimination in the Region of the Americas ........35 References ...................................................................................................................................37 Annexes .......................................................................................................................................39 4 ACRONYMS GTMP: Global Trachoma Mapping Project MDA: Mass drug administration NIDs: Neglected infectious diseases PAHO: Pan American Health Organization SAFE: Surgery, Antibiotic, Face cleanliness and Environmental improvement STH: Soil-transmitted helminth infections TF: Trachomatous inflammation, follicular TS: Trachomatous scarring TT: Trachomatous trichiasis UNICEF: United Nations Children's Fund USAID: United States Agency for International Development WASH: Water, Sanitation and Hygiene WHO: World Health Organization 5 GLOSSARY Mass drug administration (MDA): In public SAFE (Surgery, Antibiotics, Facial cleanliness health, this refers to an intervention in which and Environmental improvement) strategy: drugs are periodically administered to the entire This strategy is recommended by WHO for the population at risk of suffering from a neglected elimination of trachoma as a public health infectious disease in a specific geographical area, problem. It represents a set of actions that regardless of whether or not an individual has the includes surgery for people with trachomatous infection (1). trichiasis, antibiotic treatment for populations living in trachoma endemic areas, and facial Elimination of a disease as a public health hygiene and environmental improvement to reduce problem: This term is used when disease control disease transmission (3). goals are achieved in a way that leads to reduced transmission and burden of a disease. As soon Water, Sanitation and Hygiene strategy: This as these goals are achieved, a specific disease or strategy, which is recommended by WHO and disability may no longer be considered a problem UNICEF, provides a framework to guide integrated of public health importance or zero incidence of a actions to improve the supply of drinking water, specific disease may even be attained, leading to sanitation and hygienee (4). elimination of the disease (2). Soil-transmitted helminth infections (STH): Neglected infectious diseases (NIDs): This These are parasitosis acquired through contact refers to a group of diseases that are caused with contaminated soil. This document refers by parasites, viruses, and bacteria and for specifically to helminth infections caused by which comprehensive, intersectoral control and hookworms (Necator americanus and Ancylostoma elimination activities have been recommended. duodenale), Ascaris lumbricoides, and Trichuris These diseases are considered “neglected” since trichiura (5). their occurrence and persistence are associated with communities’ socioeconomic conditions, including poverty and lack of access to or insufficient basic services. 6 SUMMARY The Fifth Regional Meeting of Managers of National Programs for the Elimination of Trachoma as a Public Health Problem in the Americas brought together collaborators, strategic partners, and representatives of the countries that are implementing activities for trachoma control and elimination in the Region: Brazil,