@article{fdi:010071425,
  title = {{I}mpact of the {E}bola outbreak on {T}rypanosoma brucei gambiense infection medical activities in coastal {G}uinea, 2014-2015 : a retrospective analysis from the {G}uinean national {H}uman {A}frican {T}rypanosomiasis control program},
  author = {{C}amara, {M}. and {O}uattara, {E}. and {D}uvignaud, {A}. and {M}igliani, {R}. and {C}amara, {O}. and {L}eno, {M}. and {S}olano, {P}hilippe and {B}ucheton, {B}runo and {C}amara, {M}. and {M}alvy, {D}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {T}he 2014-2015 {E}bola outbreak massively hit {G}uinea. {T}he coastal districts of {B}offa, {D}ubreka and {F}orecariah, three major foci of {H}uman {A}frican {T}rypanosomiasis ({HAT}), were particularly affected. {W}e aimed to assess the impact of this epidemic on sleeping sickness screening and caring activities. {M}ethodology/{P}rincipal findings {W}e used preexisting data from the {G}uinean sleeping sickness control program, collected between 2012 and 2015. {W}e described monthly: the number of persons (i) screened actively; (ii) or passively; (iii) treated for {HAT}; (iv) attending post-treatment follow-up visits. {W}e compared clinical data, treatment characteristics and {D}isability {A}djusted {L}ife-{Y}ears ({DALY}s) before ({F}ebruary 2012 to {D}ecember 2013) and during ({J}anuary 2014 to {O}ctober 2015) the {E}bola outbreak period according to available data. {W}hereas 32,221 persons were actively screened from {F}ebruary 2012 to {D}ecember 2013, before the official declaration of the first {E}bola case in {G}uinea, no active screening campaigns could be performed during the {E}bola outbreak. {F}ollowing the reinforcement and extension of {HAT} passive surveillance system early in 2014, the number of persons tested passively by month increased from 7 to 286 between {A}pril and {S}eptember 2014 and then abruptly decreased to 180 until {J}anuary 2015 and to none after {M}arch 2015. 213 patients initiated {HAT} treatment, 154 (72%) before {E}bola and 59 (28%) during the {E}bola outbreak. {T}hose initiating {HAT} therapy during {E}bola outbreak were recruited through passive screening and diagnosed at a later stage 2 of the disease (96% vs. 55% before {E}bola, p<0.0001). {T}he proportion of patients attending the 3 months and 6 months post-treatment follow-up visits decreased from 44% to 10% (p <0.0001) and from 16% to 3% (p = 0.017) respectively. {T}he {DALY}s generated before the {E}bola outbreak were estimated to 48.7 (46.7-51.5) and increased up to 168.7 (162.7-174.7), 284.9 (277.1-292.8) and 466.3 (455.7-477.0) during {E}bola assuming case fatality rates of 2%, 5% and 10% respectively among under-reported {HAT} cases. {C}onclusions/{S}ignificance {T}he 2014-2015 {E}bola outbreak deeply impacted {HAT} screening activities in {G}uinea. {A}ctive screening campaigns were stopped. {P}assive screening dramatically decreased during the {E}bola period, but trends could not be compared with pre-{E}bola period (data not available). {F}ew patients were diagnosed with more advanced {HAT} during the {E}bola period and retention rates in follow-up were lowered. {T}he drop in newly diagnosed {HAT} cases during {E}bola epidemic is unlikely due to a fall in {HAT} incidence. {E}ven if we were unable to demonstrate it directly, it is much more probably the consequence of hampered screening activities and of the fear of the population on subsequent confirmation and linkage to care. {R}einforced program monitoring, alternative control strategies and sustainable financial and human resources allocation are mandatory during post {E}bola period to reduce {HAT} burden in {G}uinea.},
  keywords = {{GUINEE}},
  booktitle = {},
  journal = {{PLOS} {N}eglected {T}ropical {D}iseases},
  volume = {11},
  numero = {11},
  pages = {e0006060 [15 p.]},
  ISSN = {1935-2735},
  year = {2017},
  DOI = {10.1371/journal.pntd.0006060},
  URL = {https://www.documentation.ird.fr/hor/fdi:010071425},
}