RESEARCH ARTICLE Mass Drug Administration for Trachoma: How Long

Background Blinding trachoma is targeted for elimination by 2020 using the SAFE strategy (Surgery, An-tibiotics, Facial cleanliness, and Environmental improvements). Annual mass drug adminis-tration (MDA) with azithromycin is a cornerstone of this strategy. If baseline prevalence of clinical signs of trachomatous inflammation – follicular among 1-9 year-olds (TF1-9) is 10 % but<30%, the World Health Organization guidelines are for at least 3 annual MDAs; if30%, 5. We assessed the likelihood of achieving the global elimination target of TF1-9 <5 % at 3 and 5 year evaluations using program reports. Methodology/Principal Findings We used the International Trachoma Initiative’s prevalence and treatment database. Of 283 cross-sectional survey pairs with baseline and follow-up data, MDA was conducted in 170 districts. Linear and logistic regression modeling was applied to these to investigate the ef-fect of MDA on baseline prevalence. Reduction to<5 % was less likely, though not impossi-ble, at higher baseline TF1-9 prevalences. Increased number of annual MDAs, as well a