Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, MD, USA.
Proctor Foundation, University of California San Francisco, San Francisco, CA, USA.
Sci Rep. 2024 Jul 19;14(1):16654. doi: 10.1038/s41598-024-67245-w.
One criterion for validation of trachoma elimination is the management of Trachomatous Trichiasis (TT) after Trachoma inflammation-follicular (TF) is eliminated in children ages 1-9 years at district level. No data exist on how long countries must have dedicated TT programs, as the timeline for progression to TT from trachomatous scarring is unknown. We used eight years of longitudinal data in women in Kongwa Tanzania to model progression from no scarring (S0) through grades of scarring severity (S1-S4) to TT. Markov models were used, with age, community prevalence of TF (CPTF), and household characteristics as co-variates. Adjusted for covariates, the incidence of S1 was estimated at 4∙7% per year, and the risk increased by 26% if the CPTF was between 5-10% and by 48% if greater than 10%. The transition from S4 to TT was estimated at 2∙6% per year. Districts, even after elimination of TF, may have some communities with TF ≥ 5% and increased risk of incident scarring. Once scarring progresses to S2, further progression is not dependent on CPTF. These data suggest that, depending on the district level of scarring and degree of heterogeneity in CPTF at the time of elimination, incident TT will still be an issue for decades.
沙眼消除的一个标准是在地区一级消除儿童 1-9 岁的沙眼滤泡性炎症（TF）后，对沙眼性倒睫（TT）进行管理。由于从沙眼性瘢痕进展为 TT 的时间尚不清楚，因此关于各国必须开展 TT 项目的时间长短尚无数据。我们在坦桑尼亚 Kongwa 的女性中使用了八年的纵向数据，对从无瘢痕（S0）到不同严重程度的瘢痕（S1-S4）再到 TT 的进展进行建模。使用马尔可夫模型，将年龄、社区 TF 流行率（CPTF）和家庭特征作为协变量。调整协变量后，S1 的发病率估计为每年 4.7%，如果 CPTF 在 5-10%之间，则风险增加 26%，如果大于 10%，则风险增加 48%。从 S4 到 TT 的转变估计为每年 2.6%。即使在消除 TF 后，地区可能仍有一些社区的 TF≥5%，且发生瘢痕的风险增加。一旦瘢痕进展到 S2，进一步进展则不依赖于 CPTF。这些数据表明，取决于地区瘢痕水平和消除时 CPTF 的异质性程度，未来几十年内，新发性 TT 仍将是一个问题。
