Ten years of trachoma elimination in rural Western Australia: lessons from the field
Huppatz, C., Gibson, R., Castledine, H., Cross, K., Custodio, J., Davies, J., Gilles, M., Jones, P., Lester, M., Mak, D. B., Mullane, R., Symonds, L., Ward, J., Wood, M., & Woollacott, C. (2017). Ten years of trachoma elimination in rural Western Australia: lessons from the field. 14th National Rural Health Conference.
Introduction: Trachoma is an important eye infection, responsible for 8 million cases of trichiasis worldwide, a condition which can lead to blindness. The international Alliance for Global Elimination of Trachoma by the year 2020 (GET2020) is a WHO-led initiative which unites countries, including Australia, in a commitment to eliminate trachoma as a public health problem by 2020. Australia has several areas in which endemic trachoma persists, including rural and remote Aboriginal Communities in Western Australia (WA). The WA Trachoma Program was formed by the WA Country Health Service in 2006, and applies evidence based guidelines, and a coordinated strategic approach to reducing trachoma across WA. We review program data and discuss their implications for trachoma elimination in Australia, identifying key lessons learned.
Methods: Reported trachoma screening data from more than 50 Aboriginal Communities across WA were analysed to provide an understanding of program progress. Key challenges and barriers to effective implementation were explored as well as reflections from key stakeholders. The impact of identified program milestones and key program decisions are analysed with respect to the changing rates of trachoma prevalence in WA.
Results: Trachoma prevalence remote Aboriginal Communities in WA has dropped from 23% in 2006 to 2.6% in 2015. Other program measures also improved over this time, with the number of ‘at risk’ communities screened increasing from 75% to 100%, and the number of children in the target group screened increasing from 39% to 89%. Program milestones that facilitated these successes included: clearly identified KPIs; a coordinated approach to screening; innovative workforce solutions; formation of a Program Reference Group; increased funding and excellent relationships with key stakeholders and Aboriginal Communities.
Discussion: As Australia nears its target of eliminating trachoma as a public health problem by 2020, significant challenges to this goal remain. New programmatic issues threaten the achievement of elimination including the limitations of current screening tools, the highly mobile Aboriginal population; decoupling of data analysis from program delivery; and program fatigue. New strategies are required to address these issues: greater coordination between jurisdictional programs; renewed Community engagement with the use of more effective, evidence-based health promotion strategies; and a sharp focus on key social determinants, particularly environmental conditions.
Conclusion: Trachoma is a worldwide problem and Australia is the only developed country with endemic trachoma. The WA Trachoma Program has demonstrated that a flexible but strategic approach reduces trachoma prevalence as we near our target of elimination by 2020.
Trachoma, reduction, elimination, The WA Trachoma Program, Aboriginal Australians, Indigenous Australians