AbstractBackgroundGambiense human African trypanosomiasis (gHAT) is a disease targeted for elimination of transmission (EOT) by 2030, however the likelihood of achieving it is unknown. We utilised modelling to study the impact of currently-available intervention methods on transmission across the Democratic Republic of Congo (DRC) – which accounts for ∼ 70% of global burden – and highlight regions requiring intensified interventions.MethodsA model previously fitted to case data in DRC was used to predict cases and new infections under four future strategies in 168 health zones. The strategies comprise of medical interventions – active and passive screening (AS and PS) and some include large-scale vector control (VC). In each health zone, we estimate the median year of EOT and the probability of EOT by 2030 under each and compute the least ambitious strategy predicted to achieve EOT by 2030.FindingsThe model predicts 42 health zones are very likely to achieve EOT (> 90% probability) using medical-only strategies continued at mean coverage levels; this increases to 52 when AS coverage is increased to maximum previous coverage. In all VC strategies, health zones are predicted to meet EOT by 2030, although there are several where increasing low AS coverage could achieve this.InterpretationThis analysis provides a priority list for consideration for supplementary VC implementation (Bagata, Bandundu, Bolobo, Kikongo, Kwamouth and Masi Manimba in former Bandundu province) in conjunction with the recent AS coverage.FundingBill Melinda Gates Foundation [OPP1177824, OPP1184344, OPP1156227, OPP1186851, and OPP1155293] and Belgian Development Agency (ENABEL).Research in contextEvidence before this studyOn 30th April 2020 we searched PubMed and ScienceDirect to identify previous predictive modelling studies of gHAT in DRC using the search terms “model” AND “Democratic Republic of Congo” OR “DRC” AND “try-panosomiasis” OR “sleeping sickness”. There are numerous modelling studies which have looked at estimating the impact of a variety of strategies on transmission and elimination, however many utilise infection prevalence categories for performing simulations rather than location-specific data. For DRC, modelling studies have made projections at a province-level (i.e. Bandundu), and for health zones (i.e all of Equateur and some in Bandundu), concluding that there is high heterogeneity in underlying transmission, consequently whether medical-only strategies will suffice to meet elimination of transmission (EOT) by 2030. They find that supplemental, large-scale vector control would be expected to result in rapid EOT across settings. Two high-endemicity, village-level studies suggest that regular, high-coverage screening is needed to achieve EOT within 15 years without additional interventions.Added value of this studyThis study presents predictions for EOT across the whole DRC for the first time. Since DRC has the highest disease burden it is critical to understand how far current tools might go towards achieving this 2030 target across the country, and how strategies may need to be adapted for specific locations in the endgame. It also provides a priority list for regions requiring intensified interventions.Implications of all the available evidenceOur analysis suggests that, whilst many regions of DRC are expected to meet the EOT goal by 2030 with medical-only strategies, for some regions current strategies may need to be bolstered to achieve EOT within the next decade. Although some regions could consider increasing coverage of active screening, vector control appears a desirable supplemental intervention in several specific high-prevalence locations.
Demonstrating the sustainability of capacity strengthening amidst COVID-19
