A randomized trial of two coverage targets for mass treatment with azithromycin for trachoma. The World Health Organization recommends at least 3 annual antibiotic mass drug administrations (MDA) where the prevalence of trachoma is >10% in children ages 1-9 years, with coverage at least at 80%. However, the additional value of higher coverage targeted at children with multiple rounds is unknown. 32 communities with prevalence of trachoma ≥20% were randomized to: annual MDA aiming for coverage of children between 80%-90% (usual target) versus aiming for coverage>90% (enhanced target); and to: MDA for three years versus a rule of cessation of MDA early if the estimated prevalence of ocular C. trachomatis infection was less than 5%. The primary outcome was the community prevalence of infection with C. trachomatis at 36 months.
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