@article{fdi:010090059,
  title = {{T}owards the sustainable elimination of gambiense human {A}frican trypanosomiasis in {C}ote d'{I}voire using an integrated approach},
  author = {{K}aba, {D}. and {K}offi, {M}. and {K}ouakou, {L}. and {N}'{G}ouan, {E}. {K}. and {D}johan, {V}. and {C}ourtin, {F}abrice and {N}'{D}jetchi, {M}. {K}. and {C}oulibaly, {B}. and {A}dingra, {G}. {P}. and {B}erte, {D}. and {T}a, {B}. {T}. {D}. and {K}one, {M}. and {T}raore, {B}. {M}. and {S}utherland, {S}. {A}. and {C}rump, {R}. {E}. and {H}uang, {C}. {I}. and {M}adan, {J}. and {B}essell, {P}. {R}. and {B}arreaux, {A}. and {S}olano, {P}hilippe and {C}rowley, {E}. {H}. and {R}ock, {K}. {S}. and {J}amonneau, {V}incent},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground{H}uman {A}frican trypanosomiasis is a parasitic disease caused by trypanosomes among which {T}rypanosoma brucei gambiense is responsible for a chronic form (g{HAT}) in {W}est and {C}entral {A}frica. {I}ts elimination as a public health problem ({EPHP}) is being achieved. {C}ote d'{I}voire was one of the first countries to be validated by {WHO} in 2020 and this was particularly challenging as the country still reported around a hundred cases a year in the early 2000s. {T}his article describes the strategies implemented including a mathematical model to evaluate the reporting results and infer progress towards sustainable elimination. {M}ethods{T}he control methods used combined both exhaustive and targeted medical screening strategies including the follow-up of seropositive subjects considered as potential asymptomatic carriers to diagnose and treat cases as well as vector control to reduce the risk of transmission in the most at-risk areas. {A} mechanistic model was used to estimate the number of underlying infections and the probability of elimination of transmission ({E}o{T}) between 2000-2021 in two endemic and two hypo-endemic health districts. {R}esults{B}etween 2015 and 2019, nine g{HAT} cases were detected in the two endemic health districts of {B}ouafle and {S}infra in which the number of cases/10,000 inhabitants was far below 1, a necessary condition for validating the {EPHP}. {M}odelling estimated a slow but steady decline in transmission across the four health districts, bolstered in the two endemic health districts by the introduction of vector control. {T}he decrease in underlying transmission in all health districts corresponds to a high probability that {E}o{T} has already occurred in {C}ote d'{I}voire. {C}onclusion{T}his success was achieved through a multi-stakeholder and multidisciplinary one health approach where research has played a major role in adapting tools and strategies to this large epidemiological transition to a very low prevalence. {T}his integrated approach will need to continue to reach the verification of {E}o{T} in {C}ote d'{I}voire targeted by 2025. {A}uthor summary{S}ignificant efforts to control {T}rypanosoma brucei gambiense human {A}frican trypanosomiasis (g{HAT}) have drastically reduced the prevalence of the disease and elimination of transmission ({E}o{T}) is targeted for 2030 by {WHO}. {T}his reduction was particularly challenging in {C}ote d'{I}voire as it still faced epidemic episodes in the early 2000s. {T}his large epidemiological transition to very low prevalence necessitated the adaptation and evolution of both medical and vector control strategies described in this article. {A} mathematical model was also used to retrospectively analyse case reporting results, indicating with high probability that local {E}o{T} has already been achieved in the four health districts analysed.{W}ith nine g{HAT} cases detected in two health districts between 2015 and 2019 and less than one case per 10,000 people per year in all health districts at national level over this five-year period, {C}ote d'{I}voire received validation by {WHO} of achievement of the elimination of the disease as a public health problem in 2020. {T}hese results combined with the modelling offer encouragement regarding reaching the verification of {E}o{T} targeted by 2025 in {C}ote d'{I}voire on condition of maintaining such multidisciplinary one health approach including research activities to continuously adapt it to the epidemiological transition to zero incidence.},
  keywords = {{COTE} {D}'{IVOIRE}},
  booktitle = {},
  journal = {{PL}o{S} {N}eglected {T}ropical {D}iseases},
  volume = {17},
  numero = {7},
  pages = {e0011514 [25 ]},
  ISSN = {1935-2735},
  year = {2023},
  DOI = {10.1371/journal.pntd.0011514},
  URL = {https://www.documentation.ird.fr/hor/fdi:010090059},
}