Development and implementation of a strategy for intensified screening for gambiense human African trypanosomiasis in Kongo Central province, DRC.
Development and implementation of a strategy for intensified screening for gambiense human African trypanosomiasis in Kongo Central province, DRC.
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在刚果民主共和国金刚省中部省的甘戈人非洲锥虫病的加强筛查战略的制定和实施。
DOI：
10.1371/journal.pntd.0008779
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发表时间：
2020-10
影响因子：
3.8
通讯作者：
Ndung'u JM
中科院分区：
文献类型：
--
作者：
Lumbala C;Kayembe S;Makabuza J;Lutumba P;Van Geertruyden JP;Bessell PR;Ndung'u JM
刚果民主共和国（DRC）占报告的冈比亚人类非洲锥虫病（HAT）病例的大多数。刚果民主共和国的刚果中部省报告的病例数量相对较低，但稳定，并与安哥拉和刚果共和国形成跨界重点。本文描述了一项干预措施，旨在通过改进被动病例检测，辅以被动筛查，减少刚果中部的病例负担。在2015年8月启动该方案时，确定了620个卫生设施，并为其配备了用于HAT筛查的快速诊断检测仪。其中，603家（97%）报告使用了rdt， 584家（94%）在2016年最后一个季度继续使用rdt，用于后续分析。在所涉及的所有卫生设施中，23个设施配备了通过显微镜确认HAT的设备，后者中有4个设施配备了利用环介导等温扩增（LAMP）进行分子检测的设备。临床怀疑患有HAT的患者进行RDT检测，RDT阳性的患者被转诊到最近的显微镜检查机构进行确认性检测。如果RDT阳性患者在显微镜下呈阴性，则对新鲜血液或用滤纸干燥并运送到执行LAMP的设施的血液进行LAMP检测。这一诊断设施网络将患者前往筛查设施的中间距离从过去使用经典的卡凝集试验（CATT）作为筛查试验时的13.7公里减少到3.4公里。因此，与之前相比，被动病例检出率提高了30%至130%。此外，通过被动筛查在早期疾病中发现HAT病例的比例从27%增加到64%。在被动筛查报告病例的20个村庄以及这些村庄附近的45个村庄进行了被动筛查。反应性筛查负责检测40%的病例，其中90%处于疾病的第一阶段。该规划表明，有可能在刚果民主共和国的分国家或国家一级对HAT进行被动筛查，并且在辅以被动筛查的情况下，这种筛查会更加有效。结果和成就表明，发现的HAT病例数量有所增加，其中大多数是早期疾病，表明这一战略能够提高人口覆盖率和早期发现病例，这对于消除HAT水库和阻断传播至关重要，并有助于在实施该战略的区域消除HAT。最近开发了一些HAT诊断测试，以改进病例发现。我们报告在一项战略中使用这些技术，以增加刚果民主共和国中部刚果省HAT病例的覆盖率和早期发现。重点地区的所有620个卫生设施都配备了RDTs，以检测出现疑似HAT症状的患者。在这些卫生设施中，有23个得到升级，可以进行确认性检测，以进行最终诊断。这一策略缩短了患者前往HAT筛查机构的距离，从13.7公里减少到3.4公里。2015年8月至2016年12月，每年调整后的HAT病例检测比例较前两年增加了30%至130%，其中64%为早期疾病，而此前为27%。这一战略提高了人口覆盖率，并在辅以反应性筛查的情况下，发现当地疫情和早期发现大多数病例，这对于消除HAT病毒库和阻断传播至关重要，从而有助于消除该疾病。
The Democratic Republic of the Congo (DRC) accounts for the majority of the reported gambiense human African trypanosomiasis (HAT) cases. Kongo Central province in the DRC reports a relatively low, yet steady number of cases, and forms a transboundary focus with Angola and the Republic of Congo. This paper describes an intervention aimed at reducing the case burden in Kongo Central by improving passive case detection, complemented with reactive screening. At the initiation of this programme in August 2015, 620 health facilities were identified and equipped with Rapid Diagnostic Tests (RDTs) for HAT screening. Of these, 603 (97%) reported use of RDTs, and 584 (94%) that continued to use RDTs to the last quarter of 2016 were used in the analysis going forward. Among all health facilities involved, 23 were equipped to confirm HAT by microscopy, and 4 of the latter were equipped to perform molecular testing with loop-mediated isothermal amplification (LAMP). Patients clinically suspected of HAT were tested with an RDT and those with a positive RDT result were referred to the nearest microscopy facility for confirmatory testing. If RDT positive patients were negative by microscopy, they were tested by LAMP, either on fresh blood or blood that was dried on filter paper and transported to a facility performing LAMP. This network of diagnostic facilities reduced the median distance for a patient to travel to a screening facility from 13.7km when the classical card agglutination test for trypanosomiasis (CATT) was used as a screening test in the past, to 3.4km. As a consequence, passive case detection was improved by between 30% and 130% compared to the period before. Furthermore, the proportion of HAT cases detected in early stage disease by passive screening increased from 27% to 64%. Reactive screening took place in 20 villages where cases were reported by passive screening, and in 45 villages in the neighbourhood of these villages. Reactive screening was responsible for detection of 40% of cases, of which, 90% were in first stage of the disease. This programme has demonstrated that it is possible to deploy passive screening for HAT at sub-country or country levels in the DRC, and this is made more effective when supplemented with reactive screening. Results and achievements showed an increase in the number of HAT cases detected, the majority of them in early disease, demonstrating that this strategy enables better population coverage and early detection of cases, which is critical in removing the HAT reservoir and interrupting transmission, and could contribute to HAT elimination in regions where it is implemented. A number of diagnostic tests for HAT have recently been developed, to improve case detection. We report on the use of these technologies in a strategy to increase coverage and early detection of HAT cases in Kongo Central province of DRC. All 620 health facilities in the focus were equipped with RDTs to test patients presenting with symptoms suggestive of HAT. Among these health facilities, 23 were upgraded to perform confirmatory testing, for a final diagnosis. This strategy has reduced the distance a patient travels to a facility screening for HAT, from 13.7km to 3.4km. From August 2015 to December 2016, the proportion of HAT cases detected, adjusted annually, increased by between 30% and 130% compared to the previous two years, and 64% of them were in early stage disease, compared to 27% previously. This strategy has enabled better population coverage, and when supplemented with reactive screening, the identification of local outbreaks and early detection of most cases, which is critical in removing the HAT reservoir and interrupting transmission, thus contributing to elimination of the disease.
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影响因子：
3.8
作者：
Mitashi P;Hasker E;Ngoyi DM;Pyana PP;Lejon V;Van der Veken W;Lutumba P;Büscher P;Boelaert M;Deborggraeve S
通讯作者：
Deborggraeve S
影响因子：
3.7
作者：
Wamboga C;Matovu E;Bessell PR;Picado A;Biéler S;Ndung'u JM
通讯作者：
Ndung'u JM
影响因子：
3.7
作者：
Bessell PR;Lumbala C;Lutumba P;Baloji S;Biéler S;Ndung'u JM
通讯作者：
Ndung'u JM
影响因子：
4.9
作者：
Lumbala, Crispin;Simarro, Pere P.;Jannin, Jean G.
通讯作者：
Jannin, Jean G.
影响因子：
3.8
作者：
Hayashida K;Kajino K;Hachaambwa L;Namangala B;Sugimoto C
通讯作者：
Sugimoto C