Stop transmission of gambiense human African trypanosomiasis

ongoing

Gambiense human African trypanosomiasis (gHAT) is a neglected tropical disease caused by trypanosome parasites. gHAT is fatal if left untreated. So far, treatment options for gHAT were limited and toxic, forcing control programs to avoid overtreatment through complex diagnostic procedures, including screening with a serological test, laborious microscopic confirmation of seropositives and lumbar puncture for disease stage determination. This resulted in loss of up to 50% of gHAT cases, which remained untreated. Recently a non-toxic single dose oral drug, acoziborole, has shown 98.1% efficacy in a phase III trial, irrespective of gHAT disease stage. Acoziborole removes the need for lumbar puncture and appears safe enough to treat serological suspects without microscopic confirmation (Screen & treat). The STROGHAT project 1° will evaluate effectiveness of a Screen & treat approach to rapidly reduce gHAT prevalence in an entire focus; 2° will extend acoziborole safety documentation; 3° and will analyze costs of this new approach. To achieve these objectives, Screen & treat will be implemented, actively and passively, for 3 consecutive years in the gHAT focus of Nord Equateur in D.R. Congo. Available geographical information will be exploited to specifically target villages where gHAT was recently, or still is present. Detection at a reference laboratory, of the trypanosomes nucleic acids in blood collected before treatment, will retrospectively identify true gHAT cases among the treated serological suspects. After 3 years of intervention, the gHAT prevalence in the focus will be re-estimated. STROGHAT intends to provide the first evidence for recommending Screen & treat to national HAT control programs for elimination of gHAT. Through facilitated diagnosis, increased acceptability and access to treatment, STROGHAT will contribute to achieving the goal of stopping gHAT transmission by 2030, as defined by the World Health Organization.