Human African trypanosomiasis progress

HAT (also known as sleeping sickness) is caused by an infection, with parasites transmitted to humans through the bites of infected tsetse flies. The disease manifests in two forms: chronic infection with Trypanosoma brucei gambiense (g-HAT) and acute infection with T. brucei rhodesiense (r-HAT).

The steady decrease in the global number of new patients with human African trypanosomiasis (HAT) continued in 2016, strongly suggesting that the programme will meet its 2020 elimination target, defined as fewer than 2,000 cases reported globally. Only 2,184 cases were reported in 2016, after screening some 2.3 million people in a robust programme that reached thousands of villages in logistically challenging locations at risk for HAT. This provides assurance that the decreasing number of new cases is not due to under-detection.

The Belgian government pledged significant new support this year, leveraging additional support from the Bill & Melinda Gates Foundation. In addition, during 2015 and 2016, WHO convened several meetings of the WHO Network for HAT Elimination, a large multi-sectoral partnership of stakeholders. The network strengthens collaboration and supports national programmes by leading and coordinating the actions of all stakeholders in each endemic country. Strategic advances in monitoring, evaluation and data management have also been seen.

WHO has introduced new indicators and has trained national data managers, resulting in better information on populations and areas at risk and on access to diagnosis and treatment. This will help the programme to target surveillance and interventions. Programmes should nevertheless use vector control to supplement case detection and treatment as part of the elimination strategy. Furthermore, programme expertise should be made available to country health systems, including peripheral health centres, to prevent the disease from reappearing after elimination.

The results of research on a new oral treatment are anxiously awaited, as there are serious problems with current therapy, which requires intravenous infusion by skilled personnel

The new generation of rapid diagnostic tests has increased surveillance, but additional steps are required for verification of positive test results. Research is under way on asymptomatic human carriage and animal reservoirs, new diagnostic tools for surveillance in elimination settings, and HAT and NTD modelling by consortia to support country and global programme decision-making.