Age-based targeting of biannual azithromycin distribution for child survival in Niger: an adaptive cluster-randomized trial protocol (AVENIR).
In: BMC public health, Jg. 21 (2021-04-29), Heft 1, S. 822
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Zugriff:
Background: Biannual distribution of azithromycin to children 1-59 months old reduced mortality by 14% in a cluster-randomized trial. The World Health Organization has proposed targeting this intervention to the subgroup of children 1-11 months old to reduce selection for antimicrobial resistance. Here, we describe a trial designed to determine the impact of age-based targeting of biannual azithromycin on mortality and antimicrobial resistance.
Methods: AVENIR is a cluster-randomized, placebo-controlled, double-masked, response-adaptive large simple trial in Niger. During the 2.5-year study period, 3350 communities are targeted for enrollment. In the first year, communities in the Dosso region will be randomized 1:1:1 to 1) azithromycin 1-11: biannual azithromycin to children 1-11 months old with placebo to children 12-59 months old, 2) azithromycin 1-59: biannual azithromycin to children 1-59 months old, or 3) placebo: biannual placebo to children 1-59 months old. Regions enrolled after the first year will be randomized with an updated allocation based on the probability of mortality in children 1-59 months in each arm during the preceding study period. A biannual door-to-door census will be conducted to enumerate the population, distribute azithromycin and placebo, and monitor vital status. Primary mortality outcomes are defined as all-cause mortality rate (deaths per 1000 person-years) after 2.5 years from the first enrollment in 1) children 1-59 months old comparing the azithromycin 1-59 and placebo arms, 2) children 1-11 months old comparing the azithromycin 1-11 and placebo arm, and 3) children 12-59 months in the azithromycin 1-11 and azithromycin 1-59 arms. In the Dosso region, 50 communities from each arm will be followed to monitor antimicrobial resistance. Primary resistance outcomes will be assessed after 2 years of distributions and include 1) prevalence of genetic determinants of macrolide resistance in nasopharyngeal samples from children 1-59 months old, and 2) load of genetic determinants of macrolide resistance in rectal samples from children 1-59 months old.
Discussion: As high-mortality settings consider this intervention, the results of this trial will provide evidence to support programmatic and policy decision-making on age-based strategies for azithromycin distribution to promote child survival.
Trial Registration: This trial was registered on January 13, 2020 (clinicaltrials.gov: NCT04224987 ).
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Age-based targeting of biannual azithromycin distribution for child survival in Niger: an adaptive cluster-randomized trial protocol (AVENIR).
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Autor/in / Beteiligte Person: | O'Brien, KS ; Arzika, AM ; Amza, A ; Maliki, R ; Ousmane, S ; Kadri, B ; Nassirou, B ; Mankara, AK ; Harouna, AN ; Colby, E ; Lebas, E ; Liu, Z ; Le, V ; Nguyen, W ; Keenan, JD ; Oldenburg, CE ; Porco, TC ; Doan, T ; Arnold, BF ; Lietman, TM |
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Zeitschrift: | BMC public health, Jg. 21 (2021-04-29), Heft 1, S. 822 |
Veröffentlichung: | London : BioMed Central, [2001-, 2021 |
Medientyp: | academicJournal |
ISSN: | 1471-2458 (electronic) |
DOI: | 10.1186/s12889-021-10824-7 |
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