{"id":10987,"date":"2025-05-21T10:14:42","date_gmt":"2025-05-21T10:14:42","guid":{"rendered":"https:\/\/blogs.lshtm.ac.uk\/iceh-new\/?page_id=10987"},"modified":"2026-04-01T15:25:12","modified_gmt":"2026-04-01T15:25:12","slug":"stronger-safe","status":"publish","type":"page","link":"https:\/\/blogs.lshtm.ac.uk\/iceh-new\/stronger-safe\/","title":{"rendered":"Stronger-SAFE"},"content":{"rendered":"

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Stronger-SAFE<\/h1>\n

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The World Health Organisation recommended approach for tackling trachoma is SAFE<\/strong>: S<\/strong>urgery for trichiasis, A<\/strong>ntibiotics to treat infection, promotion of F<\/strong>acial cleanliness and E<\/strong>nvironmental improvements to supress transmission of infection.<\/p>\n

Despite the implementation of this strategy in areas around the world, trachoma remains an endemic disease, with 103 million people living in trachoma-endemic areas, and 1.9 million people living with blindness from the condition.<\/p>\n

With this in mind, strategies are needed to ensure that trachoma is addressed as comprehensively as possible. Stronger-SAFE launched in 2018, as a multi-year research project with three main aims:<\/p>\n

1. Increasing our understanding of how trachoma is transmitted<\/p>\n

2. Developing strategies for improved trachoma control<\/p>\n

3. Testing these strategies in a trachoma endemic population in a clinical trial<\/p>\n

Transmission was assessed by testing people and household objects for C. Trachomatis<\/em>, observing contact behaviours and the behaviour of flies on people\u2019s faces. People\u2019s eyes, face, hands and clothing as well as flies and household objects were tested to understand in much greater detail than previously attempted where the bacterium could be detected to identify putative transmission routes.<\/p>\n

Fly control and WASH (water, sanitation and hygiene) interventions were then co-designed with the local communities and stakeholders.<\/p>\n

In the main trial, we randomised 68 clusters (around 45,000 people) to test whether enhanced azithromycin treatment combined with targeted transmission-interrupting strategies (the interventions developed in phase 2) could more effectively eliminate trachoma than current approaches.<\/p>\n

The project recently came to a close, finding that:<\/p>\n