Enhanced passive screening and diagnosis for gambiense human African trypanosomiasis in north-western Uganda - Moving towards elimination.
Enhanced passive screening and diagnosis for gambiense human African trypanosomiasis in north-western Uganda - Moving towards elimination.
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DOI：
10.1371/journal.pone.0186429
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Ndung'u JM
中科院分区：
文献类型：
--
作者：
Wamboga C;Matovu E;Bessell PR;Picado A;Biéler S;Ndung'u JM
乌干达冈比亚人非洲锥虫（gHAT）的发病率一直在下降，从2008年的198例下降到2012年的20例。通过早期诊断和治疗阻断疾病传播是控制和最终消除gHAT的核心。直到最近，可用的筛查测试的形式限制了中央卫生设施的筛查和诊断（被动筛查）。我们描述了一种新的战略，有助于消除gHAT在乌干达通过扩大被动筛查的整个人群的风险。在这一战略中，使用快速诊断测试（RDT）对在初级卫生设施临床怀疑患有gHAT的患者进行筛查，然后在战略位置的显微镜中心进行寄生虫学确认。对于RDT呈阳性而显微镜检查呈阴性的患者，血液样本将使用环介导等温扩增（LAMP）进行进一步检测，这是一种检测寄生虫DNA的分子检测。LAMP阳性患者被认为是强烈的嫌疑人，并通过显微镜重新评估。根据乌干达7个gHAT流行区所有公共卫生保健设施的地理参考和特征描述结果，确定了进行显微镜检查和LAMP的设施的位置和升级。对3个设施进行了升级，以进行RDT、显微镜检查和LAMP，对9个设施进行了升级，以进行RDT和显微镜检查，对200个设施进行了升级，以筛查患有RDT的患者。这将病人必须旅行进行gHAT筛查的距离从之前的23公里减少到了2.5公里的中位数距离。在这一战略中，2014年诊断出9例gHAT病例，2015年诊断出4例。这一增强的gHAT被动筛查战略已全面覆盖高危人群，并正在其他gHAT流行国家推广。病例发现方面的改进使乌干达消灭这种疾病成为一种迫在眉睫的可能性。
The incidence of gambiense human African trypanosomiasis (gHAT) in Uganda has been declining, from 198 cases in 2008, to only 20 in 2012. Interruption of transmission of the disease by early diagnosis and treatment is core to the control and eventual elimination of gHAT. Until recently, the format of available screening tests had restricted screening and diagnosis to central health facilities (passive screening). We describe a novel strategy that is contributing to elimination of gHAT in Uganda through expansion of passive screening to the entire population at risk. In this strategy, patients who are clinically suspected of having gHAT at primary health facilities are screened using a rapid diagnostic test (RDT), followed by parasitological confirmation at strategically located microscopy centres. For patients who are positive with the RDT and negative by microscopy, blood samples undergo further testing using loop-mediated isothermal amplification (LAMP), a molecular test that detects parasite DNA. LAMP positive patients are considered strong suspects, and are re-evaluated by microscopy. Location and upgrading of facilities to perform microscopy and LAMP was informed by results of georeferencing and characterization of all public healthcare facilities in the 7 gHAT endemic districts in Uganda. Three facilities were upgraded to perform RDTs, microscopy and LAMP, 9 to perform RDTs and microscopy, and 200 to screen patients with RDTs. This reduced the distance that a sick person must travel to be screened for gHAT to a median distance of 2.5km compared to 23km previously. In this strategy, 9 gHAT cases were diagnosed in 2014, and 4 in 2015. This enhanced passive screening strategy for gHAT has enabled full coverage of the population at risk, and is being replicated in other gHAT endemic countries. The improvement in case detection is making elimination of the disease in Uganda an imminent possibility.