Abstract
Gambiense human African trypanosomiasis (gHAT) is marked for elimination of transmission (EOT) by 2030, but the disease persists in several low-income countries. We coupled transmission and health outcomes models to examine the cost-effectiveness of four gHAT elimination strategies in in five settings – spanning low- to high-risk – of the Democratic Republic of Congo. Alongside passive screening (PS) in fixed health facilities, the strategies included active screening (AS) at average or intensified coverage levels, alone or with vector control (VC) with a scale-back algorithm when no cases were reported for three consecutive years. In high or moderate-risk settings, costs of gHAT strategies are primarily driven by AS and, if used, VC. Due to the cessation of AS and VC, most investments (75-80%) will be made by 2030 and VC might be cost-saving while ensuring EOT. In low-risk settings, costs are driven by PS, and minimum-cost strategies consisting of AS and PS lead to EOT by 2030 with high probability.
Competing Interest Statement
The authors have declared no competing interest.
Funding Statement
This work was supported by the Bill and Melinda Gates Foundation (www.gatesfoundation.org) through the Human African Trypanosomiasis Modelling and Economic Predictions for Policy (HAT MEPP) project [OPP1177824] (MA, CH, REC, PB, MJK, KSR, and FT), through the NTD Modelling Consortium [OPP1184344, OPP1156227, and OPP1186851] (KSR and MJK), and through the TRYP-ELIM-BANDUNDU project [OPP1155293] (EMM and RS) and the Directorate-general Development Cooperation and Humanitarian Aid (EMM). The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
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Footnotes
Format for a new journal.
Data Availability
Full model (including the fitting code) and documentation are available through OpenScienceFramework (OSF).