@article{fdi:010083148,
  title = {{P}assive surveillance of human {A}frican trypanosomiasis in {C}ote d'{I}voire : understanding prevalence, clinical symptoms and signs, and diagnostic test characteristics},
  author = {{K}one, {M}. and {K}aba, {D}. and {K}abore, {J}. and {T}homas, {L}. {F}. and {F}alzon, {L}. {C}. and {K}offi, {M}. and {K}ouame, {C}. {M}. and {A}houty, {B}. and {C}ompaore, {C}. {F}. {A}. and {N}'{G}ouan, {E}. {K}. and {S}olano, {P}hilippe and {F}evre, {E}. and {B}uscher, {P}. and {L}ejon, {V}eerle and {J}amonneau, {V}incent},
  editor = {},
  language = {{ENG}},
  abstract = {{A}uthor summary {A}s human {A}frican trypanosomiasis ({HAT}) or sleeping sickness is approaching elimination, case management is progressively transferred from specialized teams to front line health care centres. {T}his approach raises practical questions. {W}hat clinical symptoms and signs should trigger {HAT} testing? {W}hat rapid diagnostic tests ({RDT}) are suitable for screening? {W}hich unconfirmed serological suspects should be examined further? {D}uring this study conducted in {C}ote d'{I}voire, individuals with sleep disturbances, motor disorders, convulsions, severe weight loss, or psychiatric problems were more often positive in {RDT}s. {T}hese symptoms and signs should trigger referral for {HAT} screening. {O}ur results confirm appropriateness of the existing {HAT} screening strategy with {SD} {B}ioline {HAT} or {HAT} {S}ero-{K}-{S}et having specificities of 97.8% and 98.9%. {S}ubsequent tests on dried blood spots from {RDT} positives were 93.3% to 98.9% specific, and increased the positive predictive value from below 15% up to 67%. {F}or selection of {RDT} seropositives for additional parasitological examinations, trypanolysis on dried blood spots is suitable, but could be replaced by {ELISA}, which can be performed locally. {T}he optimal diagnostic test algorithm for {C}ote d'{I}voire, in terms of cost-effectiveness, remains to be determined. {B}ackground {L}ittle is known about the diagnostic performance of rapid diagnostic tests ({RDT}s) for passive screening of human {A}frican trypanosomiasis ({HAT}) in {C}ote d'{I}voire. {W}e determined {HAT} prevalence among clinical suspects, identified clinical symptoms and signs associated with {HAT} {RDT} positivity, and assessed the diagnostic tests' specificity, positive predictive value and agreement. {M}ethods {C}linical suspects were screened with {SD} {B}ioline {HAT}, {HAT} {S}ero-{K}-{S}et and r{HAT} {S}ero-{S}trip. {S}eropositives were parasitologically examined, and their dried blood spots tested in trypanolysis, {ELISA}/{T}bg, m18{S}-q{PCR} and {LAMP}. {T}he {HAT} prevalence in the study population was calculated based on {RDT} positivity followed by parasitological confirmation. {T}he association between clinical symptoms and signs and {RDT} positivity was determined using multivariable logistic regression. {T}he tests' {P}ositive {P}redictive {V}alue ({PPV}), specificity and agreement were determined. {R}esults {O}ver 29 months, 3433 clinical suspects were tested. {T}he {RDT} positivity rate was 2.83%, {HAT} prevalence 0.06%. {I}ndividuals with sleep disturbances (p<0.001), motor disorders (p = 0.002), convulsions (p = 0.02), severe weight loss (p = 0.02) or psychiatric problems (p = 0.04) had an increased odds (odds ratios 1.7-4.6) of being {HAT} {RDT} seropositive. {S}pecificities ranged between 97.8%-99.6% for individual {RDT}s, and 93.3-98.9% for subsequent tests on dried blood spots. {T}he {PPV} of the individual {RDT}s was below 14.3% ({CI} 2-43), increased to 33.3% ({CI} 4-78) for serial {RDT} combinations, and reached 67% for {LAMP} and {ELISA}/{T}bg on {RDT} positives. {A}greement between diagnostic tests was poor to moderate ({K}appa <= 0.60), except for {LAMP} and {ELISA}/{T}bg ({K}appa = 0.66). {C}onclusion {I}dentification of five key clinical symptoms and signs may simplify referral for {HAT} {RDT} screening. {T}he results confirm the appropriateness of the diagnostic algorithm presently applied, with screening by {SD} {B}ioline {HAT} or {HAT} {S}ero-{K}-{S}et, supplemented with trypanolysis. {ELISA}/{T}bg could replace trypanolysis and is simpler to perform.},
  keywords = {{COTE} {D}'{IVOIRE}},
  booktitle = {},
  journal = {{PL}o{S} {N}eglected {T}ropical {D}iseases},
  volume = {15},
  numero = {8},
  pages = {e0009656 [19 p.]},
  ISSN = {1935-2735},
  year = {2021},
  DOI = {10.1371/journal.pntd.0009656},
  URL = {https://www.documentation.ird.fr/hor/fdi:010083148},
}