Background: Tigray is one of the first regions in Ethiopia that implementing healthrnextension package program at household level. In 2002/2003 EC this program strengthenedrnand expanded in all woredas of the Region. Kola Tembien woreda, which is our study area,rnhas 4000 households which are graduated and involved in the program for the last 3 years.rnObjective: To assess the impact of having HEP on active trachoma prevalence, andrnidentify challenges, achievements and factors for sustainable implementation of thernprogram.rnMethodology: This is a quasi-experimental study conducted in Kola Tembien District.rnUsing systematic random sampling 310 households from intervention and 621 householdsrnfrom non-intervention households were interviewed in 31 randomly selected villages.rnOphthalmic nurses use a simplified clinical grading to assess stages of trachoma whilernenvironmental technicians assessed risk factors of trachoma. Qualitative data were alsorncollected through FGDs to identify community perception on household HEP program andrnthe relation within all stakeholders, major achievements and challenges, and mechanismsrnused to sustain the program.rnResults: Prevalence of active trachoma in under ten years in household with HEP is 17%rnand in households without HEP is 35.5%. Prevalence of active trachoma is lower amongrnhouseholds with HEP [OR: 0.37 95% CI, 0.22-0.63]; who have latrine and used properlyrn[OR:0.62 95%CI, 0.38-0.95]. who washed face frequently [OR:0.10 95%CI, 0.05-0.18],rnwho used soap to wash face [OR:0.37 95%CI, 0.15-0.94]; and clean face [OR:0.40 95%CI,rn0.29-0.57] but higher in those who dispose waste to disposal pit [OR:1.43 95%CI, 1.04-rn1.95] and distance to fetch water less than one kilometers [OR:1.47 95%CI, 1.00-2.15]. ThernFGDs suggested that households who implement the HEP program prevented eye diseasesrnand eye irritation and they internalize importance of the HEP program.rnConclusion: Health extension package has significant effect in prevention of activerntrachoma and has to be expanded to households who have not implemented the HEPrnprogram. Further sensitization and training of woreda and kebele councils, health workersrnand CHW and make understanding with stakeholders like Agriculture, Education, Waterrndevelopment and Cooperatives is necessary to enhance expansion of the program.rnKey words: Health extension package, Active trachoma, quasi-experimental stud