• M Soledad Castaño, Maryam Aliee, Mwamba Miaka Erick E Programme National de Lutte contre la Trypanosomiase Humaine Africaine, Kinshasa, the Democratic Republic of the Congo., Matt J Keeling, Nakul Chitnis, and Kat S Rock.
• Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
• J. Infect. Dis. 2020 Jun 11; 221 (Suppl 5): S539-S545.

BackgroundGambiense human African trypanosomiasis ([gHAT] sleeping sickness) is a vector-borne disease that is typically fatal without treatment. Intensified, mainly medical-based, interventions in endemic areas have reduced the occurrence of gHAT to historically low levels. However, persistent regions, primarily in the Democratic Republic of Congo (DRC), remain a challenge to achieving the World Health Organization's goal of global elimination of transmission (EOT).MethodsWe used stochastic models of gHAT transmission fitted to DRC case data and explored patterns of regional reporting and extinction. The time to EOT at a health zone scale (~100 000 people) and how an absence of reported cases informs about EOT was quantified.ResultsRegional epidemiology and level of active screening (AS) both influenced the predicted time to EOT. Different AS cessation criteria had similar expected infection dynamics, and recrudescence of infection was unlikely. However, whether EOT has been achieved when AS ends is critically dependent on the stopping criteria. Two or three consecutive years of no detected cases provided greater confidence of EOT compared with a single year (~66%-75% and ~82%-84% probability of EOT, respectively, compared with 31%-51%).ConclusionsMultiple years of AS without case detections is a valuable measure to assess the likelihood that the EOT target has been met locally.© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.

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