Feasibility of community-based control of tsetse: Apilot project using Tiny Targets in the Democratic Republic of Congo.

Catiane Vander Kelen,Steve J Torr,Marleen Boelaert,Dennis Pérez Chacón,Justin Pulford,Erick Miaka,Alain Mpanya,Richard Selby,Ricardo E Gürtler

doi:10.1371/journal.pntd.0008696

Abstract

Gambiense Human African Trypanosomiasis (g-HAT) is a neglected tropical disease caused by trypanosomes transmitted by tsetse flies. 70% of cases in 2019 (604/863) occurred in the Democratic Republic of Congo (DRC). The national programme for g-HAT elimination in DRC includes a large-scale deployment of Tiny Targets which attract and kill tsetse. This intervention is directed by vector-control specialists with small teams, moving in canoes, deploying Tiny Targets along riverbanks where tsetse concentrate. While the targets are deployed in communal areas, and the method is cheap and easy-to-use, local people have little involvement. This study aimed to evaluate if a community-led vector control programme was feasible in the context of DRC’s g-HAT elimination programme. In 2017, a community-led intervention was implemented in three villages in the Kwilu province of DRC. This intervention was evaluated through an Action Research with qualitative data collected through 21 focus group discussions and 289 hours of observation. Also the geographical location and quality of each Tiny Targets were collected (total number deployed = 2429). This research revealed that community-based approach largely worked: people were motivated and proactive, showed a good application of the acquired knowledge resulting in an effective deployment of Tiny Targets. In addition, our study provided evidence that acceptability of the targets by the community can improve deployment quality by reducing target loss and damage. The approach was feasible in places where canoe-based teams could not reach. Against these advantages, a community-based approach was time-consuming and had to adapt to the seasonal and daily rhythms of the community. A community-based approach for tsetse control is technically feasible and recommended but limits to the speed and scale of the approach restraints its application as a standalone strategy in a large-scale national programme aiming to eliminate g-HAT in a short timeframe.

Highlights

We found that Tiny Targets were well accepted by local people who deployed targets effectively, but the speed and scale of the deployment was limited by the underlying movement of local people and the rhythms of their life
Human African trypanosomiasis (HAT), known as sleeping sickness, is a fatal disease caused by Trypanosoma brucei gambiense or T.b.rhodesiense both transmitted by tsetse flies
HAT detection rates during active screening may be lower than 50% of the actual existing cases [1] resulting in continuing transmission within these communities [6,7,8,9]

Summary

Introduction

Human African trypanosomiasis (HAT), known as sleeping sickness, is a fatal disease caused by Trypanosoma brucei gambiense or T.b.rhodesiense both transmitted by tsetse flies. It is a public health problem unique to sub-Saharan Africa where it affects mainly poor and rural populations. The approach has led to a massive decrease in the DRC burden of g-HAT from 16,951 cases in 2000 to just 604 in 2019 [2] Despite this achievement, models predict that sole reliance on active screening and treatment strategy will not achieve to interrupt transmission by 2030 [5]. Tiny Targets have already been used effectively in Uganda, Guinea, Ivory Coast and Chad [1, 12, 13]

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Conclusion