Background

The global program to eliminate trachoma as a public health problem continues to be extremely successful, with 14 countries validated and over 100 million people no longer requiring mass drug administration with donated Zithromax®. The global elimination targets are achievable, but there are a small minority of districts, in a few countries, in which delivery of the SAFE strategy in its current form has not resulted in the expected progress towards trachoma elimination.

To address this issue, a WHO Informal Consultation hosted by the International Trachoma Initiative (ITI) in December 2021 agreed on definitions for those evaluation units (EUs) that have persistent or recrudescent transmission and would benefit from a modified approach, and what may be included in that modified approach.

Working definitions for two categories of districts affected have been agreed as follows:

• Persistent TF: EUs in which there have been at least two trachoma impact surveys (TIS) in which the prevalence of the indicator trachomatous inflammation—follicular (TF) among children aged 1–9 years (TF_1–9) has never been below 5% (and the current TF_1–9 is≥5%)
• Recrudescent TF: EUs in which there has been at least one trachoma surveillance survey (TSS) at which TF_1–9 ≥5% (and the current TF_1–9 is ≥5%)

Following the WHO Informal Consultation, the Trachoma Expert Committee (TEC) of ITI invited countries to request additional Zithromax® for EUs that fit the criteria of persistent and recrudescent TF and would benefit from modified treatment and/or enhanced monitoring strategies. To guide these strategies and inform planning and evaluation, there is a need for operational research (OR) using standardized methods.

Scope

With this call, the Neglected Tropical Diseases Support Center (NTD-SC), which serves as the Secretariat of the Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD), in collaboration with the ITI, invites country programs grappling with persistent and/or recrudescent active trachoma to apply for funding to undertake OR to address key endgame challenges. These may include:

1. Assessments to better understand the underlying causes of persistent and recrudescent active trachoma. Potential factors include low MDA coverage, missed MDAs, role of nomadic populations, etc.
2. Sampling strategies that incorporate new diagnostic indicator(s)
3. Approaches to find, treat and measure missed populations (enhanced coverage), and understand lack of uptake

Costing, feasibility, and acceptability of aforementioned enhanced monitoring strategies should also be included. The research should use and adapt standardized protocols to enable comparisons within and across countries and build the evidence base on endgame strategies for trachoma elimination.

Standardized protocols will be agreed upon by a protocol review group that includes strong representation from national programs and local partners.  These protocols will be made available to interested applicants who respond via the web form and will also be posted on this page as they are finalized. Interested applicants should select the protocol(s) that best address the challenges and adapt them to the local situation.

Projects will be funded through NTD-SC with support from the Bill & Melinda Gates Foundation (Gates Foundation) and the United States Agency for International Development (USAID).

Award information

Submissions will be accepted on a rolling basis and will be submitted directly by country programs for review by the TEC research subcommittee initially to ensure consistency between country programs and availability of additional Zithromax®. Local researchers and organizations working directly with country programs may be involved in OR funding applications. Proposals will then be evaluated, and ultimate award decision determined, in collaboration with the Gates Foundation, USAID, and NTD-SC. Technical guidance on proposal development, budgeting, and OR implementation is available and will be provided through NTD-SC.

Proposal evaluation metrics

The following criteria will be used in proposal evaluation:

Submission Instructions

Any additional Zithromax® required for the proposed work should be included in a Zithromax® Application submitted to ITI by the national trachoma program of the Ministry of Health. For more details on this process, please contact ITI.

Submissions will be made through the following web form: https://app.smartsheet.com/b/form/9b80ebe22711471abb2da453f89ff737

Submissions should include the following documents:

• Study protocol (standardized protocol(s) tailored to specific country context, including information about the persistent/recrudescent EUs to be included in the study)
• Study budget (on NTD-SC budget template)
  • Budget template & Budget guidelines-see attachments below
• Project timeline (in Excel matrix)

For questions about this RFP, please contact Katie Gass (kgass@taskforce.org).

*** All interested applicants are strongly encouraged to register their interest in the RFP by completing this web form, which includes questions about the location(s) of the prospective district(s) and any factors that may be contributing to the persistent or recrudescent trachoma.  After submitting this form, applicants will be contacted with more information regarding suggested protocol(s) for the submitted district(s).