Treatment-related characteristics of communities in districts characterized by persistent trachoma: an exploratory descriptive study.

Background: Despite the implementation of surgery, antibiotics mass administration, facial cleanliness and environmental improvement, commonly known as the SAFE strategy for several years, the persistence and recrudescence of trachoma is a prevailing challenge in Ethiopia. This study explores the treatment-related characteristics of communities within districts characterized by persistent trachoma in southern Ethiopia.

Methods: Nyangatom and Uba Debretsehay districts are predominantly inhabited by pastoralist and farming communities, respectively. A community-based, exploratory descriptive qualitative study was conducted from June to October 2023. A total of 11 key informant interviews and six focus group discussions were conducted. The interviews and discussions were digitally recorded, transcribed and thematically analysed using Atlas ti. 23.

Results: Districts characterized by persistent trachoma are characterized by segments of populations that have never been treated or suboptimally treated. This is due to the competing priorities faced by providers, the nature of campaigns and the limited ability of logistics to reach the 'must reach' population. Other barriers include limited social support and terrain hindering full geographical and population coverage. Treatment slippage is of particular concern because of treatment fatigue, misinformation and the unavailability of treatments for routine care.

Conclusions: Communities in districts characterized by persistent and recrudescent trachoma face various socioecological barriers that impact the outcome of SAFE strategy implementation. A mix of both random and systematic omissions of people who need treatment most, such as children and women, was evident.