RESUMO
Community-wide distribution of azithromycin, otherwise known as mass drug administration (MDA), is a component of the World Health Organization-endorsed SAFE strategy for the elimination of trachoma as a public health problem. In the Republic of South Sudan, 2.9 million people are known to live in areas that are known to require interventions and warrant MDA. This study estimated the total costs and cost per person treated during MDA in two counties, Kapoeta North and Kapoeta East, in South Sudan. MDA was conducted in Kapoeta North and Kapoeta East counties from October 2020 to January 2021. Following training and community sensitization, a core team, consisting of a height measurer, a drug dispenser, and a data recorder, delivered the intervention. A detailed costing database was developed in Microsoft Excel. An ingredients approach was used to capture all financial and economic costs incurred from a payer perspective. Primary outcomes included the total cost of MDA in each county and the cost per person treated in each county. In Kapoeta North, 58,226 people were treated at a financial cost of $71,350 USD. This corresponds to a unit cost of $1.22 per person treated. The total economic cost of the intervention was $99,036, at a unit cost of $1.70 per person treated. In Kapoeta East, 156,092 people were treated at a total financial cost of $168,404. This corresponds to a unit cost of $1.08 per person treated. The total economic cost of the intervention was $243,205, at a unit cost of $1.56 per person treated. The study highlights the cost variation for MDA implementation across two counties of South Sudan. As the South Sudan trachoma program expands, this information will be valuable for program planning.
RESUMO
BACKGROUND: The World Health Organization targeted trachoma for global elimination as a public health problem by 2030. Reaching elimination thresholds by the year 2030 in the Republic of South Sudan will be a considerable challenge, as the country currently has many counties considered hyper-endemic (> 30% trachomatous inflammation-follicular [TF]) that have yet to receive interventions. Evidence from randomized trials, modeling, and population-based surveys suggests that enhancements may be needed to the standard-of-care annual mass drug administration (MDA) to reach elimination thresholds in a timely manner within highly endemic areas. We describe a protocol for a study to determine the cost and community acceptability of enhanced antibiotic strategies for trachoma in South Sudan. METHODS: The Enhancing the A in SAFE (ETAS) study is a community randomized intervention costing and community acceptability study. Following a population-based trachoma prevalence survey in 1 county, 30 communities will be randomized 1:1 to receive 1 of 2 enhanced MDA interventions, with the remaining communities receiving standard-of-care annual MDA. The first intervention strategy will consist of a community-wide MDA followed by 2 rounds of targeted treatment to children ages 6 months to 9 years, 2 weeks and 4 weeks after the community MDA. The second strategy will consist of a community-wide biannual MDA approximately 6 to 8 months apart. The costing analysis will use a payer perspective and identify the total cost of the enhanced interventions and annual MDA. Community acceptability will be assessed through MDA coverage monitoring and mixed-methods research involving community stakeholders. A second trachoma-specific survey will be conducted 12 months following the original survey. DISCUSSION: ETAS has received ethical clearance and is expected to be conducted between 2022 and 2023. Results will be shared through subsequent manuscripts. The study's results will provide information to trachoma programs on whether enhanced interventions are affordable and acceptable to communities. These results will further help in the design of future trachoma-specific antibiotic efficacy trials. Enhanced MDA approaches could help countries recover from delays caused by conflict or humanitarian emergencies and could also assist countries such as South Sudan in reaching trachoma elimination as a public health problem by 2030. TRIAL REGISTRATION: This trial was registered on December 1st, 2022 (clinicaltrails.org: NCT05634759).