Termsof Reference (TOR)

Background

The Fred Hollows Foundation has been working with Oromia Regional Health Bureau (ORHB) since 2012
to eliminate trachoma from the region by implementing the WHO endorsed SAFE strategy: Surgery for
trichiasis; Antibiotics to treat infection; Facial cleanliness and Environmental hygiene to reduce
transmission. Although SAFE has been successful in reducing disease burden in many areas of the world,
there is growing evidence that for hyperendemic regions, particularly in Amhara region of Ethiopia,
implementation of SAFE (even under research study conditions) does not have the anticipated effect in
reducing and eliminating disease.
The reasons for this are unclear. Currently there is very limited understanding of how ocular Ct is transmitted
between people in trachoma endemic communities. Moreover, there are few evidence-based interventions
to limit transmission or hasten elimination.

To address this challenge, a collaborative research group has been formed, and has secured funding for a
five-year program to strengthen prospects for trachoma elimination through enhancing the SAFE strategy:
Stronger SAFE. This program will be conducted over three phases: Phase 1: identify major routes of ocular
Chlamydia trachomatis transmission and their behavioural and environmental determinants; Phase 2:
develop contextually appropriate, practical, targeted approaches to interrupt these transmission routes; and
Phase 3: test, in a cluster-randomised trial, whether enhanced azithromycin treatment (two doses two weeks
apart) combined with targeted transmission-interrupting strategies can more effectively eliminate trachoma
than current approaches.
This study (“Stronger SAFE”) is a collaboration between The Federal Ministry of Health, Oromia Regional
Health Bureau (ORHB), London School of Hygiene and Tropical Medicine (LSHTM), and The Fred
Hollows Foundation. The study will be informing the implementation of the SAFE strategy at regional,
national and global level at each phase.

This study has been granted ethical approval from Ministry of Science and Technology on December 25,
2017. Following this approval, it is important to introduce the project to the zonal, Wereda and kebele
administrations and engage the public. For this, we have planned a one-day launch of the project in
Shashemene.

Project goal and Objective of this task:

The primary objective is to identify major routes of ocular Chlamydia trachomatis transmission and their
environmental and behavioural determinants, in order to develop a “map” for how Ct transmission takes
place in this environment.

Following the ethical approval from the Ministry of Science and Technology, we have nowwork FGD,
Interview and other stronger SAFE activities at Shashamane and, Shalla and Siraro Wored, So, I request
Birr 23,350 of perdiem for field work

Oumer Shafi
Stronger SAFE, Program Manager

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