A delegation of the Trypa-NO! Partnership* visited an endemic gambiense human African trypanosomiasis (gHAT or gambiense sleeping sickness) region of northwestern Uganda from 12 to 15 December 2017 to assess progress made in gHAT elimination in the country and the risk posed by the massive influx of refugees from South Sudan. The delegation included Bill & Melinda Gates Foundation (BMGF), Liverpool School of Tropical Medicine (LSTM), FIND, and the Coordinating Office for Control of Trypanosomiasis in Uganda (COCTU). They were accompanied by scientists from Warwick University, UK, and the Institute for Disease Modelling, USA, among others. The delegation also took part in a meeting of partners providing health-related humanitarian assistance to refugees in the region, and explored ways of intensifying vector control and screening for gHAT in refugee settlements.
In Uganda, FIND and LSTM have been supporting the country’s government, through COCTU, to eliminate gHAT by integrating control of tsetse fly vectors with screening and diagnosis, followed by treatment of infected people. Since the disease is also endemic in a number of counties in South Sudan, screening for gHAT in the country has been intensified but is limited to regions that are accessible. These activities have also been expanded to regions where refugees from South Sudan have settled in Uganda.
The delegation visited Bidi Bidi, the largest refugee settlement in the world, where they observed an active screening campaign that has been going on since May of this year. The campaign aims to screen over 100,000 refugees by August 2018 using rapid diagnostic tests and LAMP, a molecular test, followed by microscopy to confirm positive cases. Screening for gHAT is being intensified by including new health facilities that have been established in refugee settlements, and in other health facilities that are in regions where refugees have integrated with local communities.
To reduce the risk of increased HAT transmission, tsetse control using Tiny Targets has been stepped up and is being expanded into refugee settlements. The targets, assembled locally, are deployed along rivers during the dry season, which occurs every 6 months. The objective is to position approximately 30,000 Tiny Targets in a 6,000 km2 area by March 2018.
The partners’ meeting on 15 December, chaired by the Executive Director of COCTU, was attended by twelve organizations, including BMGF, UNHCR, WHO and Uganda government representatives. Participants were updated on current efforts to eliminate gHAT and on the integrated gHAT elimination activities going on in the region. The threat of re-introduction of gHAT through refugees was reviewed, and mitigating measures were discussed. Strategies to intensify activities within the refugee settlements, and to harmonize them with those implemented by humanitarian organizations, were also explored.
Intensified tsetse control and enhanced surveillance of gHAT will ensure that the risk of disease transmission is minimized, and that any cases in the communities are identified early and treated quickly.
*The Trypa-No! Partnership is a collaboration between FIND, the French National Research Institute for Sustainable Development (IRD), LSTM, COCTU, the National HAT Control Programmes of Chad and Guinea, the National HAT Elimination Programme, Institut Pierre Richet, and University of Daloa of Côte d’Ivoire – all groups that have been working on research and control of HAT, including HAT screening and diagnosis, treatment, and vector control, for some years. The project is funded by the Bill & Melinda Gates Foundation, which has prioritized the elimination of this disease, in accordance with the WHO 2020 Roadmap on Neglected Tropical Diseases.