Predicting the Impact of Intervention Strategies for Sleeping Sickness in Two High-Endemicity Health Zones of the Democratic Republic of Congo

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.Author Summary: Gambian sleeping sickness is a tsetse-transmitted disease which, without treatment, usually results in death. Unfortunately no medical prophylaxis exists to prevent infection in humans but curative medicines and vector control options are available. Recently there has been a push to reduce disease burden and a target incidence of 1 reported case per 10,000 people per year is hoped to be achieved in 90% of regions by 2020. Subsequently there is a goal of zero transmission by 2030. Using mathematical modelling, we assessed how different intervention strategies such as improving screening and treatment or introducing vector control can help in achieving these goals in a high endemicity setting. Following model simulation, we predict that improving current screening can reduce the time taken until the elimination targets are met. However it is very unlikely that the reported case target will by achieved by 2020 without additional vector control. We found that vector control has great potential to reduce transmission and, even if it is less effective at reducing tsetse numbers as in other regions, the full elimination goal could still be achieved by 2030. We recommend that control programmes use a combined medical and vector control strategy to help combat sleeping sickness.