Abstract
The control of Trypanosoma brucei gambiense human African trypanosomiasis (HAT) is compromised by low sensitivity of the routinely used parasitologic confirmation tests. More sensitive alternatives, such as mini-anion exchange centrifugation technique (mAECT) or capillary tube centrifugation (CTC), are more expensive. We used formal decision analysis to assess the cost-effectiveness of alternative HAT confirmation algorithms in terms of cost per life saved. The effectiveness of the standard method, a combination of lymph node puncture (LNP), fresh blood examination (FBE), and thick blood film (TBF), was 36.8%; the LNP-FBE-CTC-mAECT sequence reached almost 80%. The cost per person examined ranged from euro1.56 for LNP-FBE-TBF to euro2.99 for LNP-TBF-CTC-mAECT-CATT (card agglutination test for trypanosomiasis) titration. LNP-TBF-CTC-mAECT was the most cost-effective in terms of cost per life saved. HAT confirmation algorithms that incorporate concentration techniques are more effective and efficient than the algorithms that are currently and routinely used by several T.b. gambiense control programs.
Highlights
Human African trypanosomiasis (HAT) is a parasitic disease that affects 36 countries in sub-Saharan Africa
The specificity of the card agglutination test for trypanosomiasis (CATT) used in screening is not 100% accurate, so human African trypanosomiasis (HAT) control programs use a variable sequence of parasitologic tests as confirmation tests
All algorithms imply that only parasitologic positives will be put on stage-dependent treatment except for the fourth group, which indicates stage-dependent treatment of persons who are negative for parasites but positive by CATT titration
Summary
Human African trypanosomiasis (HAT) is a parasitic disease that affects 36 countries in sub-Saharan Africa. Trypanosoma brucei gambiense HAT control activities are based principally on the active detection of cases by population screening and subsequent treatment of infected patients. The specificity of the card agglutination test for trypanosomiasis (CATT) used in screening is not 100% accurate, so HAT control programs use a variable sequence of parasitologic tests as confirmation tests. Several authors have reported on the low sensitivity levels of HAT confirmation tests [3,4]. HAT cases missed by population screening will later be diagnosed by fixed health services operating in the same areas as the mobile teams, but almost invariably not until the late stages of the disease. A recent study of 436 case-patients conducted in Kwamouth, DRC, showed that 154 had parasitologic-confirmed HAT cases. The present study is an analysis of the cost-effectiveness and value for HAT control policy of different HAT confirmation algorithms, including serologic algorithms
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