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Modelling the impact of fexinidazole use on human African trypanosomiasis (HAT) transmission in the Democratic Republic of the Congo
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Das, Aatreyee M., Chitnis, Nakul, Burri, Christian, Paris, Daniel H., Patel, Swati, Spencer, Simon E. F., Miaka, Erick M. and Castano, Soledad (2021) Modelling the impact of fexinidazole use on human African trypanosomiasis (HAT) transmission in the Democratic Republic of the Congo. PLoS Neglected Tropical Diseases, 15 (11). e0009992. doi:10.1371/journal.pntd.0009992 ISSN 1935-2727.
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Official URL: https://doi.org/10.1371/journal.pntd.0009992
Abstract
Gambiense human African trypanosomiasis is a deadly disease that has been declining in incidence since the start of the Century, primarily due to increased screening, diagnosis and treatment of infected people. The main treatment regimen currently in use requires a lumbar puncture as part of the diagnostic process to determine disease stage and hospital admission for drug administration. Fexinidazole is a new oral treatment for stage 1 and non-severe stage 2 human African trypanosomiasis. The World Health Organization has recently incorporated fexinidazole into its treatment guidelines for human African trypanosomiasis. The treatment does not require hospital admission or a lumbar puncture for all patients, which is likely to ease access for patients; however, it does require concomitant food intake, which is likely to reduce adherence. Here, we use a mathematical model calibrated to case and screening data from Mushie territory, in the Democratic Republic of the Congo, to explore the potential negative impact of poor compliance to an oral treatment, and potential gains to be made from increases in the rate at which patients seek treatment. We find that reductions in compliance in treatment of stage 1 cases are projected to result in the largest increase in further transmission of the disease, with failing to cure stage 2 cases also posing a smaller concern. Reductions in compliance may be offset by increases in the rate at which cases are passively detected. Efforts should therefore be made to ensure good adherence for stage 1 patients to treatment with fexinidazole and to improve access to care.
Item Type: | Journal Article | ||||||
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Subjects: | R Medicine > RC Internal medicine R Medicine > RM Therapeutics. Pharmacology |
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Divisions: | Faculty of Science, Engineering and Medicine > Science > Statistics | ||||||
Library of Congress Subject Headings (LCSH): | African trypanosomiasis , African trypanosomiasis -- Transmission -- Mathematical models -- Congo (Democratic Republic), African trypanosomiasis—Prevention, Tropical medicine -- Mathematical models -- Congo (Democratic Republic), Drug development | ||||||
Journal or Publication Title: | PLoS Neglected Tropical Diseases | ||||||
Publisher: | Public Library of Science | ||||||
ISSN: | 1935-2727 | ||||||
Official Date: | 29 November 2021 | ||||||
Dates: |
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Volume: | 15 | ||||||
Number: | 11 | ||||||
Article Number: | e0009992 | ||||||
DOI: | 10.1371/journal.pntd.0009992 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||
Date of first compliant deposit: | 17 November 2021 | ||||||
Date of first compliant Open Access: | 23 December 2021 | ||||||
RIOXX Funder/Project Grant: |
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