Skip directly to page options Skip directly to A-Z link
Volume 13, Number 10—October 2007
THEME ISSUE
Global Poverty and Human Development
Research

Cost-effectiveness of Algorithms for Confirmation Test of Human African Trypanosomiasis

Pascal Lutumba*†, Filip Meheus‡, Jo Robays†, Constantin Miaka*, Victor Kande*, Philippe Büscher†, Bruno Dujardin§, and Marleen Boelaert†Comments to Author 
Author affiliations: *Programmed National de Lutte contre la Trypanosomiase Humaine Africaine, Kinshasa, Democratic Republic of Congo; †Institute of Tropical Medicine, Antwerp, Belgium; ‡Royal Tropical Institute, Amsterdam, the Netherlands; §Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium;

Main Article

Table 2

Probabilities used in baseline scenario and plausible range*

Characteristic Baseline value, % Reference Plausible range, % Reference
HAT prevalence 1.0 Annual reports PNLTHA (1995–2002) 0.5–5.0 Annual reports 
PNLTHA (1995-2002)
LNP sensitivity 18.8 (20) 18.8–58.6 (3,4)
LNP specificity 100.0 By convention NA
FBE sensitivity 3.9 (4) 3.9–22.4 (3,4)
FBE specificity 100.0 By convention NA
TBF sensitivity 27.3 (4) 27.3–34.5 (3,4)
TBF specificity 100.0 By convention NA
CTC sensitivity 56.5 (4) 29.0–73.0 (3,7)
CTC specificity 100.0 By convention NA
mAECT sensitivity 75.3 (4) 43.0–88.0 (3,7)
mAECT specificity 100.0 By convention NA
CATT whole blood sensitivity 90.4 (23) 68.8–99.2 (21–24); John M (unpub. data)
CATT whole blood specificity 96.5 (23) 83.5–98.4 (21,23,24)
CATT titration sensitivity† 78.8 (4) 78.8–100.0 In absence of data in literature, we considered the maximum of 100%
CATT titration specificity† 59.0 (4) 59.0–100.0 In absence of data in literature, we considered the maximum of 100%
Pentamidine efficacy 98.0 ‡ 98.0–99.0 (25)
Melarsoprol efficacy 90.0 ‡ 70.0–96.3 (25,26)
Latrogenic mortality of pentamidine 0.1 ‡ 0.1–0.7 (25)
Latrogenic mortality of melarsoprol 2.0 2.0–7.0 (25–27)

*HAT, human African trypanosomiasis; PNLTHA, Programme National de lutte contre la Trypanosomiase Humaine Africaine; LNP, lymph node puncture; NA, not applicable; FBE, fresh blood examination; TBF, thick blood film; CTC, capillary tube centrifugation; mAECT, mini-anion exchange centrifugation technique; CATT, card agglutination test for trypanosomiasis.
†Conditional values to CATT whole blood positive. The plausible range included the value at different end-titers (4, 16, 32).
‡Data extracted from PNLTHA/RDC annual report 1999.

Main Article

References
  1. World Health Organization. Human African trypanosomiasis (sleeping sickness): epidemiological update. Wkly Epidemiol Rec. 2006;81:69–80.PubMedGoogle Scholar
  2. Blum  J, Nkunku  S, Burri  C. Clinical description of encephalopathic syndromes and risk factors for their occurrence and outcome during melarsoprol treatment of human African trypanosomiasis. Trop Med Int Health. 2001;6:390–400. DOIPubMedGoogle Scholar
  3. Miezan  TW, Meda  AH, Doua  F, Cattand  P. Evaluation of the parasitologic technics used in the diagnosis of human Trypanosoma gambiense trypanosomiasis in the Ivory Coast. Bull Soc Pathol Exot Filiales. 1994;87:101–4.
  4. Lutumba  P, Robays  J, Miaka  C, Kande  V, Simarro  PP, Shaw  AP, The efficiency of different detection strategies of human African trypanosomiasis by T.b. gambiense. Trop Med Int Health. 2005;10:347–56. DOIPubMedGoogle Scholar
  5. Paquet  C, Castilla  J, Mbulamberi  D, Beaulieu  MF, Gastellu Etchegorry  MG, Moren  A. Trypanosomiasis from Trypanosoma brucei gambiense in the center of north-west Uganda: evaluation of 5 years of control (1987–1991). Bull Soc Pathol Exot. 1995;88:38–41.PubMedGoogle Scholar
  6. Pépin  J, Guern  C, Mercier  P, Moore  A. Utilisation du Testryp CATT pour le dépistage de la trypanosomiase à Nioki, Zaïre. Ann Soc Belg Med Trop. 1986;66:213–24.PubMedGoogle Scholar
  7. Lumsden  WHR, Kimber  CD, Evans  DA, Doig  SJ. Trypanosoma brucei: miniature anion-exchange centrifugation technique for detection of low parasitaemias: adaptation for field use. Trans R Soc Trop Med Hyg. 1979;73:312–7. DOIPubMedGoogle Scholar
  8. Woo  PTK, Kauffmann  M. The haematocrit centrifuge technique for the detection of low virulent strains of trypanosomes of the Trypanosoma congolense sub-group. Acta Trop. 1971;28:304–8.PubMedGoogle Scholar
  9. Bailey  JW, Smith  DH. The quantitative buffy coat for the diagnosis of trypanosomes. Trop Doct. 1994;24:54–6.PubMedGoogle Scholar
  10. Weinstein  MC, Fineberg  HV. Clinical decision analysis. Philadelphia: WB Saunders; 1980. p. 1–351.
  11. Drummond  MF, O'Brien  BJ, Stoddart  GL, Torrance  GW. Methods for the economic evaluation of health care programs, 2nd ed. Oxford: Oxford University Press; 1997. p. 305.
  12. Stich  A, Abel  PM, Krishna  S. Human African trypanosomiasis. BMJ. 2002;325:203–6. DOIPubMedGoogle Scholar
  13. Robays  J, Bilengue  MM, Van der Stuyft  P, Boelaert  M. The effectiveness of active population screening and treatment for sleeping sickness control in the Democratic Republic of Congo. Trop Med Int Health. 2004;9:542–50. DOIPubMedGoogle Scholar
  14. Boelaert  M, Lynen  L, Desjeux  P, Van der Stuyft  P. Cost-effectiveness of competing diagnostic-therapeutic strategies for visceral leishmaniasis. Bull World Health Organ. 1999;77:667–74.PubMedGoogle Scholar
  15. Chappuis  F, Stivanello  E, Adams  K, Kidane  S, Pittet  A, Bouvier  P. Card agglutination test for trypanosomiasis (CATT) end-dilution titer and cerebrospinal fluid cell count as predictors of human African Trypanosomiasis (Trypanosoma brucei gambiense) among serologically suspected individuals in southern Sudan. Am J Trop Med Hyg. 2004;71:313–7.PubMedGoogle Scholar
  16. Simarro  PP, Ruiz  JA, Franco  JR, Josenando  T. Attitude towards CATT-positive individuals without parasitological confirmation in the African Trypanosomiasis (T.b. gambiense) focus of Quicama (Angola). Trop Med Int Health. 1999;4:858–61. DOIPubMedGoogle Scholar
  17. Van Nieuwenhove  S, Declercq  J. Mass serodiagnosis and treatment of serological positives as a control strategy in Trypanosoma gambiensis. In: Crooy PG, editor. Symposium on the diagnosis of African Sleeping Sickness due to T. gambiense. Rixensart: Smith Kline-RIT; 1984. p. 71–5.
  18. Frézil  JL, Coulm  J, Alary  JC. Post-therapeutic evolution of patients presenting an immunological suspicion of trypanosomiasis without parasitological proof. Med Trop (Mars). 1979;39:53–6.PubMedGoogle Scholar
  19. Bruneel  H, Van den Eeckhout  A, Molisho  D, Burke  J, Degroof  D, Pépin  J. Control of Trypanosoma Gambiense trypanosomiasis. Evaluation of a strategy based on the treatment of serologically suspected cases with a single dose of diminazene. Ann Soc Belg Med Trop. 1994;74:203–15.PubMedGoogle Scholar
  20. Lutumba  P, Robays  J, Miaka  C, Mesu  VK, Molisho  D, Declercq  J, Trypanosomiasis control, Democratic Republic of Congo, 1993–2003. Emerg Infect Dis. 2005;11:1382–8.PubMedGoogle Scholar
  21. Noireau  F, Gouteux  JP, Duteurtre  JP. Diagnostic value of a card agglutination test (Testryp CATT) in the mass screening of human trypanosomiasis in the Congo. Bull Soc Pathol Exot Filiales. 1987;80:797–803.PubMedGoogle Scholar
  22. Noireau  F, Lemesre  JL, Nzoukoudi  MY, Louembet  MT, Gouteux  JP, Frezil  JL. Serodiagnosis of sleeping sickness in the Republic of the Congo: comparison of indirect immunofluorescent antibody test and card agglutination test. Trans R Soc Trop Med Hyg. 1988;82:237–40. DOIPubMedGoogle Scholar
  23. Magnus  E, Lejon  V, Bayon  D, Buyse  D, Simarro  P, Verloo  D, Evaluation of EDTA version of CATT/Trypanosoma brucei gambiense for serological screening of human blood samples. Acta Trop. 2002;81:7–12. DOIPubMedGoogle Scholar
  24. World Health Organization Expert Committee. Control and surveillance of African trypanosomiasis. Report No. 881. Geneva: The Organization; 1998.
  25. Doua  F, Boa  FY. Human trypanosomiasis in the Ivory Coast: therapy and problems. Acta Trop. 1993;54:163–8. DOIPubMedGoogle Scholar
  26. Legros  D, Evans  S, Maiso  F, Enyaru  JC, Mbulamberi  D. Risk factors for treatment failure after melarsoprol for Trypanosoma brucei gambiense trypanosomiasis in Uganda. Trans R Soc Trop Med Hyg. 1999;93:439–42. DOIPubMedGoogle Scholar
  27. Pépin  J, Milord  F, Khonde  A, Niyonsenga  T, Loko  L, Mpia  B. Gambiense trypanosomiasis: frequency of, and risk factors for, failure of melarsoprol therapy. Trans R Soc Trop Med Hyg. 1994;88:447–52. DOIPubMedGoogle Scholar

Main Article

Page created: July 01, 2010
Page updated: July 01, 2010
Page reviewed: July 01, 2010
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external