Each jurisdiction undertook screening and treatment for trachoma according to its respective protocols, and in the context of the national 2006 CDNA Guidelines for the public health management of trachoma in Australia, or the 2014 CDNA National guidelines for the public health management of trachoma in Australia which recommend specific treatment strategies depending on the prevalence of trachoma detected through screening (references 1 and 2).
In 2006, when the National Trachoma Management Program was initiated, each jurisdiction identified at-risk communities from historical prevalence data and other knowledge. Over time, additional communities have been reclassified as being at risk. Screening for trachoma focuses on the at-risk communities, but a small number of other communities designated as not-at-risk have also been screened, generally if there is anecdotal information suggesting the presence of active trachoma.
The WHO trachoma grading criteria (Appendix 1) were used to diagnose and classify individual cases of trachoma in all jurisdictions. Data collection forms for data collection at the community level were developed by the National Trachoma Surveillance and Control Reference Group, based on the CDNA guidelines (Appendix 2). Completed forms were forwarded from the jurisdictional coordinators to the NTSRU for checking and analysis. Information provided to the NTSRU at the community level for each calendar year included:
- Number of Aboriginal children aged 1-14 years screened for clean faces and the number with clean faces, by age group
- Number of Aboriginal children aged 1-14 years screened for trachoma and the number with trachoma, by age group
- Number of episodes of treatment for active trachoma, household contacts and other community members, by age group
- Number of Aboriginal adults screened for trichiasis, number with trichiasis, and the number who had surgery for trichiasis
- Community-level implementation of WHO SAFE strategies.
While data may be collected for Aboriginal children aged 0-14 years, the focus age group in all regions is the 5-9-year age group.
Community-wide treatment differs between regions. In the NT whole-of-community treatment according to the 2014 guidelines indicates the treatment of all people in the community over 3 kg in weight living in houses with children less than 15 years of age. In WA and SA whole-of-community treatment using the 2006 guidelines refers to active cases, household contacts and all children in the community aged 6 months to 14 years. Top of page
In 2013, the NT adopted the treatment and screening schedule outlined in the revised CDNA national trachoma guidelines (then in draft form). The adoption of the new guidelines allowed resources to be directed towards community-wide treatment in high-prevalence communities, and ensured resources were not consumed by annual screening in areas where the prevalence was already well established. Trachoma screening and management in the NT was undertaken through collaboration between the Department of Health (Centre for Disease Control [CDC] and Health Development) and Aboriginal Community Controlled Health Services (ACCHS). Trachoma screening was incorporated into the Healthy School-Age Kids program annual check and conducted by either local primary health-care services or community-controlled services, with support from the CDC trachoma team. The NT uses school enrolment lists, electronic health records and local knowledge to best determine the 5-9-year-old children present in the community at the time of screening. Following screening, treatment was generally undertaken by primary health-care services with support from the CDC trachoma team, particularly where community-wide treatments were required.
In 2013, community screening for trichiasis was undertaken primarily by clinic staff, ACCHS, or by optometrists or ophthalmologists from the Regional Eye Health Service based in Alice Springs. Top of page
In 2013, Country Health SA was responsible for managing the SA trachoma screening and treatment program. Country Health SA contracted with the Aboriginal Community Controlled Health Services, the Aboriginal Health Council of South Australia, Nganampa Health Service and Local Health Service providers to ensure coverage of screening services in all at-risk rural and remote areas. SA uses the Australian Bureau of Statistics census population estimates as the screening denominator in screened communities. Additional trichiasis screening activities were undertaken by the Eye Health and Chronic Disease Specialist Support Program (EH&CDSSP), coordinated by the Aboriginal Health Council of South Australia and supported by the Medical Specialist Outreach Assistance Program (MSOAP). This program provides regular visits to SA remote Aboriginal communities by optometrists and ophthalmologists. Trichiasis screening was undertaken opportunistically for adults by the contracted trachoma screening service providers, the EH&CDSSP team and also routinely as part of the Adult Annual Health Checks.
Trachoma screening and management in WA is the responsibility of Population Health Units in the Kimberley, Goldfields, Pilbara and Midwest health regions. In collaboration with the local primary health-care providers, the Population Health Units screened communities in each region within a 2-week period, in August and September. People identified with active trachoma were treated at the time of screening. Each region determines the screening denominator in a different manner: in the Goldfields the denominator is based on the school register, without adjusting for absent children, plus other children present in the community at the time of screening; in Pilbara the denominator number is based on children present in the community at the time of screening; in the Midwest the denominator is based on the school register with removal of children from the school list who were known to be absent on the day of the screening, plus any other children present in the community at the time of screening; and in the Kimberley the denominator is based on the school register, updated at the time of screening.
Trichiasis screening was undertaken in conjunction with adult influenza vaccinations. Screening of the target population also occurs with the Visiting Optometrist Scheme (VOS) in the Kimberley region. The Goldfields region also undertook additional trichiasis screening during the trachoma screening period.
In 2011, WA Health amalgamated several previously distinct communities into one single community for the purpose of trachoma surveillance because of the small populations of each community and kinship links resulting in frequent mobility between these communities. This definition alters trends presented in reports from 2010-2013. Top of page
New South Wales
In 2013, NSW Health piloted a school-based trachoma screening project in ten potentially at-risk communities in north western NSW. The project aimed to determine if there was any evidence of trachoma in Aboriginal children living in rural and remote communities in NSW. Screening and treatment were conducted by the Population Health Unit in Bathurst with support from NSW Ministry of Health. No trichiasis screening was undertaken in NSW. In NSW, the denominator used to calculate screening coverage is based on the number of Aboriginal children aged 5-9 years enrolled in the school. The denominator was not adjusted if children were absent on the day of screening.