Sanitation, Water, and Instruction in Face-washing for Trachoma I/II

Summary

SWIFT I is a series of 3 cluster-randomized trials designed to assess several alternative strategies for trachoma control in communities that have been treated with many years of mass azithromycin distributions. The first trial (named WUHA) compares communities that receive a comprehensive Water, Sanitation, and Hygiene (WASH) package to those that receive no intervention. The second trial (named TAITU-A) compares communities randomized to targeted antibiotic treatment versus those randomized to mass antibiotics for trachoma, and the third trial (TAITU-B) compares communities randomized to targeted antibiotics versus those randomized to delayed antibiotics. SWIFT II is a continuation of the first trial (WUHA I). WUHA I is an ongoing cluster-randomized trial in rural Ethiopia designed to determine the effectiveness of water, sanitation, and hygiene (WASH) for trachoma. 40 communities were randomized in a 1:1 ratio either to a comprehensive WASH package or to no intervention. The primary outcome is ocular chlamydia, monitored annually for 3 years. In WUHA II we will treat all 40 WUHA communities with a single mass azithromycin distribution after the month 36 visit, and then continue the WASH intervention only in the 20 communities originally randomized to the WASH arm. We perform annual monitoring visits at months 48, 60, 72, and 84 for the primary outcome of ocular chlamydia among 0-5 year old children. A second aim of WUHA II is to perform a diagnostic test accuracy study of the tests already being conducted as well as several novel tests for trachoma surveillance. The novel tests include inexpensive, point-of-care nucleic acid amplification tests performed on conjunctival swabs, a lateral flow assay for chlamydia seropositivity tested on dried blood spots, and an automated algorithm to detect clinical signs of trachoma from conjunctival photographs. The primary objective of the second aim is to test the sensitivity and specificity of each of these trachoma surveillance tests. By comparing the combined azithromycin-WASH communities to communities receiving mass azithromycin alone, we investigate the benefit of combining the "A", "F", and "E" components of the SAFE strategy as opposed to focusing on antibiotics alone. This is an important question given the expense of WASH interventions and the limited resources of trachoma programs.

Timeline

Start

2015-12-05

Primary completion

2024-12-31

Completion

2024-12-31

Publications

• Wittberg DM, Admassu F, Aragie S, Dagnew A, Hailu D, Tadesse Z, Zeru T, Thompson IJB, Abdu S, Beyecha S, Birhanu T, Getachew H, Getnet B, Kabtu E, Shibiru M, Tekew S, Wondimteka B, Freeman MC, Nash SD, Lietman TM, Keenan JD. The Effect of a Water, Sanitation, and Hygiene Intervention on Clinical Trachoma: A Cluster-Randomised Trial. Trop Med Int Health. 2026 Apr;31(4):457-464. doi: 10.1111/tmi.70086. Epub 2026 Jan 18.
• Frank T, Thompson IJB, Aragie S, Wittberg DM, Tadesse W, Dagnew A, Hailu D, Melo JS, Zeru T, Tadesse Z, Arnold BF, Freeman MC, Nash SD, Callahan EK, Porco TC, Lietman TM, Keenan JD. Effect of water, sanitation, and hygiene on childhood growth in Ethiopia: a cluster-randomized trial. Int J Hyg Environ Health. 2026 Jan;271:114718. doi: 10.1016/j.ijheh.2025.114718. Epub 2025 Nov 27.
• Caleon RL, Admassu F, Aragie S, Hailu D, Dagnew A, Zeru T, Wittberg DM, Thompson IJB, Abdu S, Beyecha S, Birhanu T, Getachew H, Getnet B, Kabtu E, Shibiru M, Tekew S, Wondimteka B, Lietman TM, Nash SD, Freeman MC, Keenan JD. Photographic grading to evaluate facial cleanliness and trachoma among children in Amhara region, Ethiopia. PLoS Negl Trop Dis. 2024 Jul 11;18(7):e0012257. doi: 10.1371/journal.pntd.0012257. eCollection 2024 Jul.
• Tedijanto C, Aragie S, Gwyn S, Wittberg DM, Zeru T, Tadesse Z, Chernet A, Thompson IJB, Nash SD, Lietman TM, Martin DL, Keenan JD, Arnold BF. Seroreversion to Chlamydia trachomatis Pgp3 Antigen Among Children in a Hyperendemic Region of Amhara, Ethiopia. J Infect Dis. 2024 Aug 16;230(2):293-297. doi: 10.1093/infdis/jiad602.
• Aragie S, Wittberg DM, Tadesse W, Dagnew A, Hailu D, Chernet A, Melo JS, Aiemjoy K, Haile M, Zeru T, Tadesse Z, Gwyn S, Martin DL, Arnold BF, Freeman MC, Nash SD, Callahan EK, Porco TC, Lietman TM, Keenan JD. Water, sanitation, and hygiene for control of trachoma in Ethiopia (WUHA): a two-arm, parallel-group, cluster-randomised trial. Lancet Glob Health. 2022 Jan;10(1):e87-e95. doi: 10.1016/S2214-109X(21)00409-5.
• Wittberg DM, Aragie S, Tadesse W, Melo JS, Aiemjoy K, Chanyalew M, Emerson PM, Freeman MC, Nash SD, Callahan EK, Tadesse Z, Zerihun M, Porco TC, Lietman TM, Keenan JD. WASH Upgrades for Health in Amhara (WUHA): study protocol for a cluster-randomised trial in Ethiopia. BMJ Open. 2021 Feb 22;11(2):e039529. doi: 10.1136/bmjopen-2020-039529.

Drugs

Indications