Description

In the last decade, the prevalence of Trypanosoma brucei gambiense (Tbg) human African trypanosomiasis (HAT) has drastically decreased and HAT has been targeted for elimination. Integration of HAT diagnosis and treatment in peripheral health centres and sustainable monitoring of eliminated foci are vital for Tbg HAT elimination. Development of safe and efficacious drugs applicable in an elimination context would be accelerated by the availability of an early test-of-cure. The DiTECT-HAT project consists of 3 diagnostic trials, validating the performance of diagnostic tools and algorithms for early and rapid diagnosis of Tbg HAT for passive case detection, for post-elimination monitoring and for assessing the therapeutic response. 

Firstly, for passive case detection, DiTECT-HAT determines the diagnostic performance and cost-efficiency of RDTs performed in peripheral health centres, and of diagnostic algorithms combining RDTs with serological and/or molecular tests on filter paper performed at regional reference centres. Diagnostic algorithms with high positive predictive values will improve cost-effectiveness of passive case detection and might, in the near future, allow scenarios of testing and treating without the need for parasitological confirmation.

Secondly, for post-elimination monitoring, DiTECT-HAT proposes to determine the feasibility and cost-efficiency of different diagnostic algorithms with serological and molecular high-throughput tests. General health workers performing house to house visits in eliminated HAT foci can easily collect blood on filter paper and send it to regional HAT reference centers for analysis. This trial should allow for defining thresholds for a "transmission alarm" that should trigger reactive case finding to avoid re-emergence of HAT.

Finally, the accuracy of neopterin and trypanosomal spliced leader RNA detection as early test-of-cure are determined in a therapeutic trial. Early treatment outcome assessment will speed up the development and implementation of new drugs for HAT, and improve management of relapsing patients in routine patient care.

These 3 diagnostic trials take place in low and zero prevalence areas in DR Congo, Guinea, Côte d’Ivoire and Burkina Faso with additional testing in regional HAT reference centres in DR Congo and Burkina Faso. Results of DitECT-HAT will impact on clinical decision and health outcomes, and will contribute to successful and sustainable HAT elimination.