TY - JOUR
T1 - Insights from quantitative and mathematical modelling on the proposed WHO 2030 goals for chagas disease.
AU - Collaborating Group on Chagas Disease Modelling
AU - Fabrizio, María del Carmen
AU - Schweigmann, Nicolás J.
AU - Cohen, Joel E.
AU - Zu Dohna, Heinrich
AU - e Gürtler, Ricardo
AU - Cucunubá, Zulma M.
AU - Nouvellet, Pierre
AU - Gourbière, Sébastien
AU - Villar, Juan Carlos
AU - Rabinovich, Jorge E.
AU - Levy, Michael Z.
AU - Abad-Franch, Fernando
AU - Dobson, Andy P.
AU - Basañez, Maria Gloria
N1 - Publisher Copyright:
© 2019 Collaborating Group on Chagas Disease Modelling.
PY - 2019/11
Y1 - 2019/11
N2 - Chagas disease (CD) persists as one of the neglected tropical diseases (NTDs) with a particularly large impact in the Americas. The World Health Organization (WHO) recently proposed goals for CD elimination as a public health problem to be reached by 2030 by means of achieving intradomiciliary transmission interruption (IDTI), blood transfusion and transplant transmission interruption, diagnostic and treatment scaling-up and prevention and control of congenital transmission. The NTD Modelling Consortium has developed mathematical models to study Trypanosoma cruzi transmission dynamics and the potential impact of control measures. Modelling insights have shown that IDTI is feasible in areas with sustained vector control programmes and no presence of native triatomine vector populations. However, IDTI in areas with native vectors it is not feasible in a sustainable manner. Combining vector control with trypanocidal treatment can reduce the timeframes necessary to reach operational thresholds for IDTI (<2% seroprevalence in children aged <5 years), but the most informative age groups for serological monitoring are yet to be identified. Measuring progress towards the 2030 goals will require availability of vector surveillance and seroprevalence data at a fine scale, and a more active surveillance system, as well as a better understanding of the risks of vector re-colonization and disease resurgence after vector control cessation. Also, achieving scaling-up in terms of access to treatment to the expected levels (75%) will require a substantial increase in screening asymptomatic populations, which is anticipated to become very costly as CD prevalence decreases. Further modelling work includes refining and extending mathematical models (including transmission dynamics and statistical frameworks) to predict transmission at a sub-national scale, and developing quantitative tools to inform IDTI certification, post-certification and re-certification protocols. Potential perverse incentives associated with operational thresholds are discussed. These modelling insights aim to inform discussions on the goals and treatment guidelines for CD.
AB - Chagas disease (CD) persists as one of the neglected tropical diseases (NTDs) with a particularly large impact in the Americas. The World Health Organization (WHO) recently proposed goals for CD elimination as a public health problem to be reached by 2030 by means of achieving intradomiciliary transmission interruption (IDTI), blood transfusion and transplant transmission interruption, diagnostic and treatment scaling-up and prevention and control of congenital transmission. The NTD Modelling Consortium has developed mathematical models to study Trypanosoma cruzi transmission dynamics and the potential impact of control measures. Modelling insights have shown that IDTI is feasible in areas with sustained vector control programmes and no presence of native triatomine vector populations. However, IDTI in areas with native vectors it is not feasible in a sustainable manner. Combining vector control with trypanocidal treatment can reduce the timeframes necessary to reach operational thresholds for IDTI (<2% seroprevalence in children aged <5 years), but the most informative age groups for serological monitoring are yet to be identified. Measuring progress towards the 2030 goals will require availability of vector surveillance and seroprevalence data at a fine scale, and a more active surveillance system, as well as a better understanding of the risks of vector re-colonization and disease resurgence after vector control cessation. Also, achieving scaling-up in terms of access to treatment to the expected levels (75%) will require a substantial increase in screening asymptomatic populations, which is anticipated to become very costly as CD prevalence decreases. Further modelling work includes refining and extending mathematical models (including transmission dynamics and statistical frameworks) to predict transmission at a sub-national scale, and developing quantitative tools to inform IDTI certification, post-certification and re-certification protocols. Potential perverse incentives associated with operational thresholds are discussed. These modelling insights aim to inform discussions on the goals and treatment guidelines for CD.
KW - Chagas disease
KW - Elimination as a public health problem
KW - Intradomiciliary transmission interruption
KW - NTD Modelling Consortium
KW - Trypanocidal treatment
KW - WHO guidelines
UR - http://www.scopus.com/inward/record.url?scp=85078532176&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85078532176&partnerID=8YFLogxK
U2 - 10.12688/gatesopenres.13069.1
DO - 10.12688/gatesopenres.13069.1
M3 - Article
C2 - 31781687
AN - SCOPUS:85078532176
SN - 2572-4754
VL - 3
JO - Gates Open Research
JF - Gates Open Research
M1 - 1539
ER -