Abstract
Two goals have been set for Gambian human African trypanosomiasis (HAT), the first is to achieve elimination as a public health problem in 90% of foci by 2020, and the second is to achieve zero transmission globally by 2030. It remains unclear if certain HAT hotspots could achieve elimination as a public health problem by 2020 and, of greater concern, it appears that current interventions to control HAT in these areas may not be sufficient to achieve zero transmission by 2030. A mathematical model of disease dynamics was used to assess the potential impact of changing the intervention strategy in two high-endemicity health zones of Kwilu province, Democratic Republic of Congo. Six key strategies and twelve variations were considered which covered a range of recruitment strategies for screening and vector control. It was found that effectiveness of HAT screening could be improved by increasing effort to recruit high-risk groups for screening. Furthermore, seven proposed strategies which included vector control were predicted to be sufficient to achieve an incidence of less than 1 reported case per 10,000 people by 2020 in the study region. All vector control strategies simulated reduced transmission enough to meet the 2030 goal, even if vector control was only moderately effective (60% tsetse population reduction). At this level of control the full elimination threshold was expected to be met within six years following the start of the change in strategy and over 6000 additional cases would be averted between 2017 and 2030 compared to current screening alone. It is recommended that a two-pronged strategy including both enhanced active screening and tsetse control is implemented in this region and in other persistent HAT foci to ensure the success of the control programme and meet the 2030 elimination goal for HAT.
Highlights
IntroductionGambian sleeping sickness (one of the two forms of human African trypanosomiasis, HAT) has long been a scourge to many in sub-Saharan Africa, with this virulent tsetse-borne disease persisting in numerous foci despite decades of interventions
Gambian sleeping sickness has long been a scourge to many in sub-Saharan Africa, with this virulent tsetse-borne disease persisting in numerous foci despite decades of interventions
We predict that improving current screening can reduce the time taken until the elimination targets are met
Summary
Gambian sleeping sickness (one of the two forms of human African trypanosomiasis, HAT) has long been a scourge to many in sub-Saharan Africa, with this virulent tsetse-borne disease persisting in numerous foci despite decades of interventions. Advances in tsetse control have meant that control programmes can use strategies with interventions against both the parasite and vector [2, 3] One such tsetse control method is through the use of insecticidal targets, in particular the recently developed “tiny target” [2, 4]. Some foci of the Democratic Republic of Congo (DRC) are likely to fall in the 10% which do not reach this target level Whilst these regions will probably not stop achievement of the 2020 goal, which is defined at a global rather than local level, it poses the question of whether changes to intervention strategy could be sufficient to meet the elimination as a public health problem threshold by 2020 in these more challenging areas
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