R1: It is recommended that within NT, WA and SA all communities located in remote and very remote locations should be included in the screening program at least once in a five year cycle using the rapid assessment method. A decision to continue ongoing annual screening in these communities should depend on the estimated prevalence of active trachoma found within the community.

R2: It is recommended that active trachoma screening activities should be extended, at least on a once off basis, to remote and very remote communities in NSW and Queensland using the rapid assessment method. A decision to continue ongoing annual screening in these communities should depend on the estimated prevalence of active trachoma found within the community.

R3: It is recommend that jurisdictions consider screening ‘at risk’ communities that are not located in remote and very remote areas) at least on a once off basis every five years using a rapid assessment method. A decision to continue ongoing annual screening in these communities should depend on the estimated prevalence of active trachoma found within the community.

R4: It is recommended that jurisdictions should be able to exercise some discretion in choosing not to screen communities in which there is good local evidence that active trachoma is no longer present. However, the reasons for a decision not to screen a community located in remote and very remote locations at least once in a five year cycle should be conveyed to the NTSRU.

R5: It is recommended that the CDNA Guidelines which require annual screening in trachoma endemic communities until prevalence is less than 5% for five consecutive years be incorporated into funding and performance agreements between the Commonwealth and the jurisdictions relating to the allocation of additional funds under the new trachoma eradication initiative.

R6: It is recommended that the target screening coverage rate of 80% (i.e. the number of children aged 5-9 years screened as a proportion of the estimated number of children aged 5-9 years present in the community at the time of screening) stated in the National Framework for Delivery of Trachoma Control Programs should be adopted to ensure that screening coverage is sufficient to provide a reasonable estimate of trachoma prevalence.

R7: It is recommended that the denominator used in calculating the screening coverage rate should be estimated locally at the time of screening, based on a discussion between screening staff and local school and/or health clinic staff using a list of school enrolees or local resident children within the specified age ranges.

R8: It is recommended that jurisdictions in collaboration with the NTSRU develop guidelines to be followed by screening staff in estimating the number of children in the target age group in the community at the time of screening.

R9: It is recommended that the national surveillance system data on the prevalence of active trachoma (and trichiasis) be supplemented through conducting a national eye health survey of Indigenous people about once every five years using a randomised cluster sampling method, similar to that used for the recent National Indigenous Eye Survey.

R10: It is recommended that trichiasis surveillance be enhanced by pursuing integration of screening for trichiasis with the provision of annual influenza vaccinations to Aboriginal adults and/or ‘healthy adult checks’ in at risk communities in the Northern Territory and South Australia.

R11: It is recommended that the current approach to monitoring antibiotic resistance be retained. The national trachoma surveillance system should be enhanced by the NTSRU seeking agreement from PathWest to contribute annual data on azithromycin resistance to the system.

R12: It is recommended that National Form 1 be amended to capture data on the total number of children screened who received azithromycin for active trachoma by age group (including those who received treatment outside the two week period).

R13: It is recommended that National Form 3 be amended to capture codified information related to the nature of health promotion strategies implemented under the facial cleanliness and the health promotion/education categories. A set of codes describing the range of health promotion/education programs should be developed through an analysis of programs currently reported in textual form through National Form 3.

R14: It is recommended arrangements be made at the national level to allow relevant data from the Community Housing and Infrastructure Needs Survey (CHIN) by the year (2006 and 2011 when available) to be integrated into the national Access database on trachoma surveillance (or its replacement).

R15: It is recommended that jurisdictional trachoma coordinators continue to explore opportunities to improve data collection systems and mechanisms for extracting data from local clinical systems for trachoma surveillance reporting.

R16: It is recommended that jurisdictional trachoma coordinators seek to establish arrangements with ophthalmologists designed to capture relevant information on Aboriginal persons provided with trichiasis surgery.

R17: It is recommended that the Department of Health and Ageing consider the development of a specific MBS code for trichiasis surgery.

R18: It is recommended that OATSIH consider allocating resources to assist with the development of a web based system for capturing surveillance and treatment data and allowing access to standard reports.

R19: It is recommended that the lag in the preparation of the national report be reduced through the jurisdictional and regional co-ordinators identifying and addressing the factors that contribute to late provision of data to the NTSRU; the implementation of web based data collection mechanisms (see R18) that facilitate earlier resolution of data quality issues; and the NTSRU examining opportunities to more rapidly produce the final report.

R20: It is recommended that a flexible set of reports/pivot tables be made available to jurisdictional/regional coordinators through the existing Access database or the new web based system.

R21: It is recommended that, following the implementation of recommendation R14, the national surveillance report include analyses of the relationships between housing and environmental factors and trachoma prevalence.

R22: It is recommended that the national trachoma surveillance system be enhanced through the development of training materials/packages (including web-based training modules) for training of local staff in trachoma screening and control activities.

R23: It is recommended that the quality of the national trachoma surveillance data be enhanced through the development of a training package or session with staff that collect and/or enter the data. The training package/session would involve being taught to use the Access database or its replacement as well as understanding the uses of the data at the national level.