03517nas a2200481   4500000000100000008004100001260003700042653002400079653005700103653003200160653004000192653001600232100001100248700001200259700001400271700001700285700001300302700001400315700001900329700001600348700001500364700001300379700001100392700001200403700001500415700001800430700001300448700001200461700001200473700001500485700001500500700001300515700001500528700001200543700001600555700001300571245013200584856009900716300000900815490000700824520219000831022001403021       2023                            d  bPublic Library of Science (PLoS)10aInfectious Diseases10aPublic Health, Environmental and Occupational Health10aelimination of transmission10aHuman African Trypanosomiasis (HAT)10aIvory Coast1 aKaba D1 aKoffi M1 aKouakou L1 aN’Gouan EK1 aDjohan V1 aCourtin F1 aN’Djetchi MK1 aCoulibaly B1 aAdingra GP1 aBerté D1 aTa BTD1 aKoné M1 aTraoré BM1 aSutherland SA1 aCrump RE1 aHuang C1 aMadan J1 aBessell PR1 aBarreaux A1 aSolano P1 aCrowley EH1 aRock KS1 aJamonneau V1 aMatovu E00aTowards the sustainable elimination of gambiense human African trypanosomiasis in Côte d’Ivoire using an integrated approach  uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0011514&type=printable  a1-250 v173 a<p><strong>Background:</strong> Human African trypanosomiasis is a parasitic disease caused by trypanosomes among which Trypanosoma brucei gambiense is responsible for a chronic form (gHAT) in West and Central Africa. Its elimination as a public health problem (EPHP) is being achieved. Côte d’Ivoire was one of the first countries to be validated by WHO in 2020 and this was particularly challenging as the country still reported around a hundred cases a year in the early 2000s. This article describes the strategies implemented including a mathematical model to evaluate the reporting results and infer progress towards sustainable elimination.</p>

<p><strong>Methods:</strong> The control methods used combined both exhaustive and targeted medical screening strategies including the follow-up of seropositive subjects considered as potential asymptomatic carriers to diagnose and treat cases as well as vector control to reduce the risk of transmission in the most at-risk areas. A mechanistic model was used to estimate the number of underlying infections and the probability of elimination of transmission (EoT) between 2000–2021 in two endemic and two hypo-endemic health districts.</p>

<p><strong>Results:</strong> Between 2015 and 2019, nine gHAT cases were detected in the two endemic health districts of Bouaflé and Sinfra in which the number of cases/10,000 inhabitants was far below 1, a necessary condition for validating the EPHP. Modelling estimated a slow but steady decline in transmission across the four health districts, bolstered in the two endemic health districts by the introduction of vector control. The decrease in underlying transmission in all health districts corresponds to a high probability that EoT has already occurred in Côte d’Ivoire.</p>

<p><strong>Conclusion:</strong> This success was achieved through a multi-stakeholder and multidisciplinary one health approach where research has played a major role in adapting tools and strategies to this large epidemiological transition to a very low prevalence. This integrated approach will need to continue to reach the verification of EoT in Côte d’Ivoire targeted by 2025.</p>
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