Impact of evidence-based programmatic adaptations in addressing the persistence and recrudescence of trachoma in Kajiado County, Kenya.

BACKGROUND: Confirmatory trachoma-plus surveys conducted in 2021 revealed persistent and recrudescent trachoma transmission in Kajiado West, South and Central subcounties. These findings prompted targeted investigations and programmatic adaptations to improve intervention effectiveness. METHODS: Mass drug administration (MDA) coverage improvements were validated through Coverage Evaluation Surveys (CESs). Impact was monitored via prevalence surveys from 2021 to 2024, which included ocular swabs and dried blood spots (DBS) from children. Ocular swabs were tested for Chlamydia trachomatis (Ct) using GeneXpert IV PCR, while DBS were analysed for anti-Pgp3 antibodies using a multiplex bead assay. RESULTS: CESs showed significant increases in MDA coverage: Kajiado West (56.9% to 88.2%), South (81.2% to 95.3%) and Central (69.3% to 95.3%). Trachomatous inflammation-follicular prevalence declined in all subcounties-Kajiado West (13.8% to 6.6%), South (8.1% to 5.2%), Central (18.0% to 8.0%)-and Ct infection rates dropped below 1%. Seroconversion rate trends varied, with increases in West and Central and a decrease in South. CONCLUSIONS: The programmatic adaptations were effective in achieving high treatment coverage and in reducing active trachoma and infection, with varying trends in transmission dynamics. This resulted in major progress towards elimination of trachoma and areas with residual infection requiring closer monitoring to sustain progress.