Novel diagnostic tests for human African trypanosomiasis: What is their role in primary health care services?

Datum: 13 november 2014

Locatie: University of Antwerp - Campus Drie Eiken - Building Q - Promotiezaal - Universiteitsplein 1 - 2610 Wilrijk

Tijdstip: 16 uur

Organisatie / co-organisatie: Faculty of Medicine and Health Sciences

Promovendus: Patrick Mitashi

Promotor: Prof J.-P. Van geertruyden, Prof M. Boelaert & Prof P. Lutumba

Korte beschrijving: PhD defense Patrick Mitashi - Faculty of Medicine and Health Sciences

Novel diagnostic tests for human African trypanosomiasis: What is their role in primary health care services?

Control of human African trypanosomiasis (HAT) is mainly based on active case detection and treatment of cases, relying on specialized mobile teams. This strategy led to a remarkable decrease and has led to call for integration of HAT control into the primary health care (PHC) system. Unfortunately, PHC facilities in the endemic countries are often in poor shape. However, new diagnostic tools and (oral) drugs for HAT– if proven effective – can become game changers. We evaluated CATT D10, packaged in 10 dose vials and thermostable. It operates much as the classical CATT but the use of rotator 12V constitutes a major drawback. CATT D10 is suitable for PHC but remains a screening test which requires parasitological confirmation. The loop mediated isothermal for amplification (LAMP) also showed good sensitivity, specificity and an excellent reproducibility. LAMP could replace PCR but further studies are need for its routine use. Fluorescence microscopy-based iLED is relatively easy to perform, does not require a darkroom for reading but does require 12V electricity. Its sensitivity remains too low to be used as a routine confirmatory test but it could be useful in situations where other confirmation tests cannot be performed.

From the systematic literature review, we retrieved 16 different screening and confirmation tests for HAT. The above mentioned CATT D10 was the most appropriate screening test. Confirmation of HAT diagnosis still depends on visualizing the parasite in direct microscopy and none of the currently available confirmation tests are well suited for use at PHC level.

Finally, we assessed integration of HAT case detection and management in PHC in two highly endemic districts in the DRC. Although, staff of the 43 HC visited are aware of the HAT, they lack adequate equipment for diagnosis. mAECT, the most sensitive confirmation method, is not available in any of the centres. The classical CATT test is often used without cold chain. In absence of electricity, microscopy is performed with sunlight. In all centers outpatient attendance rates are extremely low.

Research on alternative screening strategies complemented with new diagnostic tools are needed since passive case detection alone will not detect a resurgence of HAT at an early stage.