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Introduction Trachoma is caused by the bacterium Chlamydia trachomatis (Ct). The WHO recommends the SAFE strategy for trachoma elimination: Surgery for trichiasis, Antibiotics, Facial cleanliness and Environmental improvement. Multiple rounds of SAFE implementation have proven insufficient to eliminate trachoma in Ethiopia, where over 50% of the global trachoma burden remains. More effective antibiotic treatment schedules and transmission-suppressing approaches are needed. The aim of stronger SAFE is to evaluate the impact of a novel package of interventions to strengthen the A, F and E of SAFE on the prevalence of ocular Ct and trachoma in Oromia, Ethiopia.Methods and analysis 68 clusters were randomised in a 1:1:1:1 ratio to one of (1) standard A/standard F&E (standard SAFE), (2) standard A/enhanced F&E, (3) enhanced A/standard F&E or (4) enhanced A/enhanced F&E (stronger SAFE). Enhanced A includes two height-based doses of oral azithromycin (equivalent to 20 mg/kg) given as single doses 2 weeks apart, as mass drug administration, annually. Enhanced F&E includes fly control measures (permethrin-treated headwear and odour-baited traps) and face-washing hygiene behaviour change implemented at household level in selected communities. The interventions will be implemented and reinforced over 3 years.The primary outcome is the prevalence of ocular Ct by quantitative PCR in children aged 1–9 years at 36 months. A key secondary outcome is the prevalence of active (inflammatory) trachoma in the same children, assessed by validated trachoma graders and conjunctival photography. Laboratory technicians and photo-graders are masked to treatment allocation. Other important secondary analyses include process evaluations, assessment of behaviour change, fly indicators, adherence and coverage of interventions and a cost analysis.Ethics and dissemination Study protocols have been approved by the National Research Ethics Review Committee of the Ethiopian Ministry of Science and Higher Education and the London School of Hygiene & Tropical Medicine Ethics Committee. An independent data safety and monitoring board oversees the trial. Results will be disseminated through peer-reviewed publications, presentations and reports.Trial registration number ISRCTN40760473.

Introduction The WHO neglected tropical diseases (NTD) roadmap (2021–2030) proposed a shift in approach to addressing NTDs through accountability for impact, implementing integration across NTDs, mainstreaming in national health systems and ensuring country ownership. However, a major challenge has been the dearth of evidence on how to implement this shift in a resource-limited setting. The objective of this scoping review is to understand the extent and type of evidence on the mainstreaming or integration of programmes and/or interventions against NTDs into the national health system.Methods Research articles of any methodology, series, evaluations and reports published from 1995 in the English language on any peer-reviewed platforms, and WHO, universities and government or implementing partners websites that report and discuss mainstreaming or integration implementation practices or experiences of any interventions against NTDs into the health system will be included. The main databases searched on 30 October 2024 were Medical Literature Analysis and Retrieval System Online (Ovid), Embase (Ovid), Global Health (Ovid), Cochrane Database of Systematic Reviews and CENTRAL on the Cochrane Library (Wiley), and WHO Global Index Medicus. Following piloting, screening and data extraction will be undertaken independently by at least two people. Any disagreements that arise between the reviewers at each stage of the screening and selection process will be resolved through discussion, or with an additional reviewer/s. Thematic analysis will be conducted guided by the project INTEGRATE framework and the Primary Health Care Performance Initiative conceptual framework. Key information or evidence relevant to the mainstreaming of interventions against NTDs into the health system such as mainstreamed interventions and the level of health system where the mainstreaming occurred, the effectiveness of the mainstreaming, contextual differences in health system organisation between settings, and challenges and promising practices will be summarised.Ethics and dissemination Ethical approval will not be sought as our review will only include published data. The findings will be published in a peer-reviewed journal and will be disseminated at national and international research and programme review platforms.