A secondary analysis to determine countries and districts eligible for documented full geographic coverage for trichiasis case finding and outreaches

Background: The World Health Organization recommends house-to-house case searches as an option to evidence whether the elimination of trachomatous trichiasis (TT) has been reached. We sought to determine the number of trachoma-endemic countries and districts that will require either documented full geographic coverage (DFGC) or TT-only surveys.

Methods: We conducted a secondary analysis of data from the Trachoma Atlas to identify evaluation units (EUs) that require house-to-house case searches or TT-only surveys to demonstrate achievement of the elimination of TT.

Results: There were 1710 EUs with TT above the elimination prevalence target in all trachoma-endemic countries. Of those EUs, 852 (49.8%) do not have a future survey planned and will therefore potentially have to evidence through DFGC or TT-only surveys whether the elimination prevalence target for TT has been reached.

Conclusion: Of the large number of EUs that require TT-related activities, nearly half of them will need to evidence that every household in the EU has been visited by a case finder and all confirmed cases managed. Given that this is a relatively new way to evidence elimination, and countries face different sociopolitical challenges, cross-country learning and improved guidance is key to support global elimination.