28
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Enhanced passive screening and diagnosis for gambiense human African trypanosomiasis in north-western Uganda – Moving towards elimination

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Introduction

          The incidence of gambiense human African trypanosomiasis (gHAT) in Uganda has been declining, from 198 cases in 2008, to only 20 in 2012. Interruption of transmission of the disease by early diagnosis and treatment is core to the control and eventual elimination of gHAT. Until recently, the format of available screening tests had restricted screening and diagnosis to central health facilities (passive screening). We describe a novel strategy that is contributing to elimination of gHAT in Uganda through expansion of passive screening to the entire population at risk.

          Methodology / Principal findings

          In this strategy, patients who are clinically suspected of having gHAT at primary health facilities are screened using a rapid diagnostic test (RDT), followed by parasitological confirmation at strategically located microscopy centres. For patients who are positive with the RDT and negative by microscopy, blood samples undergo further testing using loop-mediated isothermal amplification (LAMP), a molecular test that detects parasite DNA. LAMP positive patients are considered strong suspects, and are re-evaluated by microscopy. Location and upgrading of facilities to perform microscopy and LAMP was informed by results of georeferencing and characterization of all public healthcare facilities in the 7 gHAT endemic districts in Uganda. Three facilities were upgraded to perform RDTs, microscopy and LAMP, 9 to perform RDTs and microscopy, and 200 to screen patients with RDTs. This reduced the distance that a sick person must travel to be screened for gHAT to a median distance of 2.5km compared to 23km previously. In this strategy, 9 gHAT cases were diagnosed in 2014, and 4 in 2015.

          Conclusions

          This enhanced passive screening strategy for gHAT has enabled full coverage of the population at risk, and is being replicated in other gHAT endemic countries. The improvement in case detection is making elimination of the disease in Uganda an imminent possibility.

          Related collections

          Most cited references31

          • Record: found
          • Abstract: found
          • Article: found
          Is Open Access

          Population Distribution, Settlement Patterns and Accessibility across Africa in 2010

          The spatial distribution of populations and settlements across a country and their interconnectivity and accessibility from urban areas are important for delivering healthcare, distributing resources and economic development. However, existing spatially explicit population data across Africa are generally based on outdated, low resolution input demographic data, and provide insufficient detail to quantify rural settlement patterns and, thus, accurately measure population concentration and accessibility. Here we outline approaches to developing a new high resolution population distribution dataset for Africa and analyse rural accessibility to population centers. Contemporary population count data were combined with detailed satellite-derived settlement extents to map population distributions across Africa at a finer spatial resolution than ever before. Substantial heterogeneity in settlement patterns, population concentration and spatial accessibility to major population centres is exhibited across the continent. In Africa, 90% of the population is concentrated in less than 21% of the land surface and the average per-person travel time to settlements of more than 50,000 inhabitants is around 3.5 hours, with Central and East Africa displaying the longest average travel times. The analyses highlight large inequities in access, the isolation of many rural populations and the challenges that exist between countries and regions in providing access to services. The datasets presented are freely available as part of the AfriPop project, providing an evidence base for guiding strategic decisions.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Clinical features, diagnosis, and treatment of human African trypanosomiasis (sleeping sickness).

            Human African trypanosomiasis, or sleeping sickness, is caused by infection with parasites of the genus Trypanosoma, transmitted by the tsetse fly. The disease has two forms, Trypanosoma brucei (T b) rhodesiense and T b gambiense; and is almost always fatal if untreated. Despite a recent reduction in the number of reported cases, patients with African trypanosomiasis continue to present major challenges to clinicians. Because treatment for CNS-stage disease can be very toxic, diagnostic staging to distinguish early-stage from late-stage disease when the CNS in invaded is crucial but remains problematic. Melarsoprol is the only available treatment for late-stage T b rhodesiense infection, but can be lethal to 5% of patients owing to post-treatment reactive encephalopathy. Eflornithine combined with nifurtimox is the first-line treatment for late-stage T b gambiense. New drugs are in the pipeline for treatment of CNS human African trypanosomiasis, giving rise to cautious optimism. Copyright © 2013 Elsevier Ltd. All rights reserved.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Eliminating Human African Trypanosomiasis: Where Do We Stand and What Comes Next>

              While the number of new detected cases of HAT is falling, say the authors, sleeping sickness could suffer the "punishment of success," receiving lower priority by public and private health institutions.
                Bookmark

                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Supervision
                Role: Data curationRole: Formal analysisRole: Writing – original draft
                Role: Formal analysisRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                12 October 2017
                2017
                : 12
                : 10
                : e0186429
                Affiliations
                [1 ] Ministry of Health, Kampala, Uganda
                [2 ] College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB), Makerere University, Kampala, Uganda
                [3 ] Epi Interventions Ltd., Edinburgh, United Kingdom
                [4 ] Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
                Universidade Nova de Lisboa Instituto de Higiene e Medicina Tropical, PORTUGAL
                Author notes

                Competing Interests: PB is an employee of Epi Interventions Ltd. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                Author information
                http://orcid.org/0000-0001-7344-628X
                http://orcid.org/0000-0001-6994-9853
                Article
                PONE-D-17-19567
                10.1371/journal.pone.0186429
                5638538
                29023573
                7f8458c8-2d4a-4826-9ea8-d1f851bf1f37
                © 2017 Wamboga et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 22 May 2017
                : 29 September 2017
                Page count
                Figures: 9, Tables: 0, Pages: 19
                Funding
                Funded by: funder-id http://data.crossref.org/fundingdata/funder/10.13039/100000865, Bill & Melinda Gates Foundation;
                Award ID: OPP1033712
                Funded by: The Republic and Canton of Geneva
                Award Recipient :
                Funded by: German Federal Ministry of Education and Research
                Funded by: funder-id http://dx.doi.org/10.13039/100009131, Direktion für Entwicklung und Zusammenarbeit;
                Funded by: UK Aid
                This project was funded by the Bill & Melinda Gates Foundation, the Republic and Canton of Geneva, the German Federal Ministry of Education and Research through KfW, the Swiss Government and UK aid from the UK government. The funders provided support in the form of salaries for authors JN, SB and AP, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.
                Categories
                Research Article
                People and Places
                Geographical Locations
                Africa
                Uganda
                Medicine and Health Sciences
                Tropical Diseases
                Neglected Tropical Diseases
                African Trypanosomiasis
                Medicine and Health Sciences
                Parasitic Diseases
                Protozoan Infections
                Trypanosomiasis
                African Trypanosomiasis
                Medicine and Health Sciences
                Infectious Diseases
                Zoonoses
                Trypanosomiasis
                African Trypanosomiasis
                Medicine and Health Sciences
                Public and Occupational Health
                Health Screening
                Medicine and Health Sciences
                Diagnostic Medicine
                Medicine and Health Sciences
                Infectious Diseases
                Infectious Disease Control
                Medicine and Health Sciences
                Parasitic Diseases
                Malaria
                Medicine and Health Sciences
                Tropical Diseases
                Malaria
                Biology and Life Sciences
                Parasitology
                Biology and Life Sciences
                Anatomy
                Body Fluids
                Blood
                Medicine and Health Sciences
                Anatomy
                Body Fluids
                Blood
                Biology and Life Sciences
                Physiology
                Body Fluids
                Blood
                Medicine and Health Sciences
                Physiology
                Body Fluids
                Blood
                Custom metadata
                The data used in the manuscript are available in the following repository. Individual case data: https://github.com/paulbessell/Uganda_gHAT_Facilities/blob/master/Uganda_gHAT_Cases.csv Health centers data: https://github.com/paulbessell/Uganda_gHAT_Facilities/blob/master/Uganda_gHAT_Facilities.csv

                Uncategorized
                Uncategorized

                Comments

                Comment on this article