Modelling the impact of fexinidazole use on human African trypanosomiasis (HAT) transmission in the Democratic Republic of the Congo\ud
| Autor: | Erick Mwamba Miaka, M. Soledad Castaño, Daniel H. Paris, Aatreyee M. Das, Christian Burri, Nakul Chitnis, Simon E. F. Spencer, Swati Patel |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Epidemiology
Trypanosoma brucei gambiense RC955-962 Disease Disease Vectors chemistry.chemical_compound Medical Conditions Arctic medicine. Tropical medicine Medicine and Health Sciences African trypanosomiasis Routes of Administration Protozoans biology medicine.diagnostic_test Pharmaceutics Transmission (medicine) Incidence (epidemiology) Eukaryota Trypanocidal Agents Insects Infectious Diseases Democratic Republic of the Congo Public aspects of medicine RA1-1270 Research Article Trypanosoma medicine.medical_specialty RM Glossina Infectious Disease Control Arthropoda Tsetse Fly Drug Therapy Intravenous Injections medicine Animals Humans Intensive care medicine Pharmacology Lumbar puncture business.industry Organisms Public Health Environmental and Occupational Health Biology and Life Sciences Tsetse fly Models Theoretical medicine.disease biology.organism_classification Invertebrates Parasitic Protozoans Insect Vectors Vector-Borne Diseases Species Interactions Trypanosomiasis African chemistry Medical Risk Factors business Zoology Entomology Trypanosomiasis Fexinidazole RC |
| Zdroj: | PLoS Neglected Tropical Diseases, Vol 15, Iss 11, p e0009992 (2021) PLoS Neglected Tropical Diseases |
| ISSN: | 1935-2727 |
| Popis: | Gambiense human African trypanosomiasis is a deadly disease that has been declining in incidence since the start of the Century, primarily due to increased screening, diagnosis and treatment of infected people. The main treatment regimen currently in use requires a lumbar puncture as part of the diagnostic process to determine disease stage and hospital admission for drug administration. Fexinidazole is a new oral treatment for stage 1 and non-severe stage 2 human African trypanosomiasis. The World Health Organization has recently incorporated fexinidazole into its treatment guidelines for human African trypanosomiasis. The treatment does not require hospital admission or a lumbar puncture for all patients, which is likely to ease access for patients; however, it does require concomitant food intake, which is likely to reduce adherence. Here, we use a mathematical model calibrated to case and screening data from Mushie territory, in the Democratic Republic of the Congo, to explore the potential negative impact of poor compliance to an oral treatment, and potential gains to be made from increases in the rate at which patients seek treatment. We find that reductions in compliance in treatment of stage 1 cases are projected to result in the largest increase in further transmission of the disease, with failing to cure stage 2 cases also posing a smaller concern. Reductions in compliance may be offset by increases in the rate at which cases are passively detected. Efforts should therefore be made to ensure good adherence for stage 1 patients to treatment with fexinidazole and to improve access to care. Author summary Sleeping sickness is a parasitic disease present in parts of Central and West Africa that is fatal if left untreated. Current case management requires unpleasant procedures such as a lumbar puncture and intravenous drug administration, but has high compliance rates as the treatment is given by hospital staff to patients. In this study, we explore the impact of a new oral treatment on compliance rates for treatment using a mathematical model fitted to data on sleeping sickness cases and screening activities. We also look at the possibility of patients being more likely to seek and access treatment since the new treatment can be used without a lumbar puncture if the patient does not display clinically severe symptoms. We find that reduced compliance, especially from patients suffering from the first less severe stage of the disease, will lead to more sleeping sickness cases and delay elimination, but increases in the number of patients seeking treatment will likely counter effects of reduced compliance. |
| Databáze: | OpenAIRE |
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