Costs and Outcomes of Integrated Human African Trypanosomiasis Surveillance System Using Rapid Diagnostic Tests, Democratic Republic of the Congo

• Main Authors: Rian Snijders, Alain Fukinsia, Yves Claeys, Epco Hasker, Alain Mpanya, Erick Miaka, Filip Meheus, Marleen Boelaert
• Format: Article
• Language: English
• Published: Centers for Disease Control and Prevention 2021-08-01
• Series: Emerging Infectious Diseases
• Subjects: human African trypanosomiasis; sleeping sickness; surveillance; diagnosis; integration; primary health services
• Online Access: https://wwwnc.cdc.gov/eid/article/27/8/20-2399_article
• ISSN: 1080-6040; 1080-6059

We integrated sleeping sickness case detection into the primary healthcare system in 2 health districts in the Democratic Republic of the Congo. We replaced a less field-friendly serologic test with a rapid diagnostic test, which was followed up by human African trypanosomiasis microscopic testing, and used a mixed costing methodology to estimate costs from a healthcare provider perspective. We screened a total of 18,225 persons and identified 27 new cases. Average financial cost (i.e., actual expenditures) was US $6.70/person screened and $4,464/case diagnosed and treated. Average economic cost (i.e., value of resources foregone that could have been used for other purposes) was $9.40/person screened and $6,138/case diagnosed and treated. Our study shows that integrating sleeping sickness surveillance into the primary healthcare system is feasible and highlights challenges in completing the diagnostic referral process and developing a context-adapted diagnostic algorithm for the large-scale implementation of this strategy in a sustainable and low-cost manner.