Das, A. M. and Chitnis, N. and Burri, C. and Paris, D. H. and Patel, S. and Spencer, S. E. F. and Miaka, E. M. and Castaño, M. S.. (2021) Modelling the impact of fexinidazole use on human African trypanosomiasis (HAT) transmission in the Democratic Republic of the Congo. PLoS Negl Trop Dis, 15 (11). e0009992.
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Abstract
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.
Faculties and Departments: | 09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) 09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Disease Modelling > Mathematical Epidemiology (Chitnis) 09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Medicine (MED) > Medicines Implementation Research (Burri) 03 Faculty of Medicine > Departement Public Health > Sozial- und Präventivmedizin > Medicines Development (Paris) 09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Medicine (MED) > Medicines Development (Paris) |
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UniBasel Contributors: | Das, Aatreyee and Chitnis, Nakul and Burri, Christian and Paris, Daniel Henry and Castaño, Soledad |
Item Type: | Article, refereed |
Article Subtype: | Research Article |
ISSN: | 1935-2735 (Electronic)1935-2727 (Linking) |
Note: | Publication type according to Uni Basel Research Database: Journal article |
Language: | English |
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edoc DOI: | |
Last Modified: | 21 Dec 2022 14:52 |
Deposited On: | 21 Dec 2022 14:52 |
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