On World Neglected Tropical Disease (NTD) Day earlier this week (30 January), more than US$7m in new funding was announced to expand efforts towards sleeping sickness elimination in nine African nations.
The funding, from the Bill & Melinda Gates Foundation, will support cost-effective, sustainable strategies to develop and maintain post-elimination surveillance programmes, building on the success of the Trypa-NO! partnership – a project led by FIND, the French National Research Institute for Sustainable Development (IRD), and the Liverpool School of Tropical Medicine (LSTM) – that has supported Chad, Côte d’Ivoire, Guinea and Uganda in their progress towards sleeping sickness elimination.
Additional funding from the Canton of Geneva will further enable the continuation of support for national elimination programmes in the Democratic Republic of the Congo and Angola. The award of nearly US$6.8m will extend the work of the Trypa-NO! partnership for a further three years.
The Trypa-NO! partnership supports the elimination of the gambiense form of human African trypanosomiasis (HAT), also known as sleeping sickness. To date, the Trypa-NO! partnership has supported Côte d’Ivoire and Uganda to achieve elimination as a public health problem. In addition, the partnership has been working with Chad and Guinea, both of which are on track to achieve this milestone soon.
The new funding will ensure that each of these four countries has a sustainable, long-term strategy to independently monitor the disease and achieve full interruption of transmission. The grant will additionally allow Trypa-NO! to begin or expand work in Angola, the Central African Republic, Sierra Leone and South Sudan.
The additional funding assistance from the Canton of Geneva in Switzerland will augment activities in the Democratic Republic of the Congo and Angola focused on integrating screening and testing at the primary care and community levels, raising awareness among healthcare workers and communities and developing strategies for the two countries to combine learnings and coordinate action.
This support brings the total new funding committed on World NTD Day, for sleeping sickness elimination, to more than US$7m.
For the past two decades, the World Health Organization (WHO) has recognised the elimination of HAT as a major priority. This disease, transmitted by the bite of the tsetse fly, can be fatal if missed and left untreated.
HAT is endemic to 36 sub-Saharan African countries and primarily affects people living in remote and rural areas, which has made monitoring the disease a challenge.
Fortunately, coordinated efforts by national programmes, supported by public–private partnerships, NGOs, donors and academia have made its elimination a realistic target.
From about 30 000 cases reported at the turn of the century to fewer than 1 000 cases annually since 2018, sleeping sickness numbers have dropped dramatically in recent years, particularly in Western and Central Africa, where the gambiense form is found.
The Trypa-NO! partnership between FIND, IRD and LSTM, launched in 2016, supports efforts to stamp out sleeping sickness by integrating diagnosis, treatment and tsetse fly control. The partnership has deployed innovative tools such rapid diagnostic tests and supported capacity building and training of healthcare workers in remote areas to enable them to screen for HAT more effectively.
The project also uses community-level diagnostic information to help target its screening activities and the use of panels of cloth impregnated with insecticide (called “tiny targets”) to attract and kill tsetse flies. The new Trypa-NO! grant allows the partnership to build on past successes and move towards a new phase of support for several countries over the next three years.
With HAT numbers low and falling, Chad, Côte d’Ivoire, Guinea and Uganda are now pivoting towards a goal of zero new infections – adapting current approaches and implementing country-specific, tailored strategies that are sustainable, integrated and cost-effective, with strengthened country-level data management for strategic decision making.
Trypa-NO! support will gradually be scaled down. In addition, by beginning or expanding efforts in Angola, the Central African Republic, Sierra Leone and South Sudan, the Trypa-NO! partnership will help these countries take steps to eliminate the disease and prevent its reintroduction into areas that have dramatically cut the number of cases.
Dr Mamadou Camara, coordinator of the HAT National Control Programme in Guinea, said: “For the Ministry of Health in Guinea, the renewal of Trypa-NO! is very good news. Not only because it validates all the efforts made with the partnership of IRD for the past decade, but it will also galvanise the team to progress toward the goal of interrupting transmission.
“The strategy of combining medical and vector control was good, but it will need to be adapted to the low prevalence context. Further integration of activities in the peripheral health system and at the community level and building synergies with other NTD programmes will be key to achieve this goal.”
Dr Sylvain Biéler, Principal Scientist in charge of the HAT portfolio at FIND and Coordinator of the Trypa-NO! Partnership said: “The continued support to Trypa-NO! will ensure that more countries can benefit from tailored elimination strategies using the latest tools developed for diagnosis, treatment, vector control and data management. Building on recent successes and on the strong partnerships that have been established, we are committed to working with countries so that the WHO elimination targets are met, and HAT soon becomes a disease of the past.”
Dr Andrew Hope, Senior Programme Manager leading the Tiny Targets portfolio at LSTM said: “Achieving elimination of sleeping sickness as a public health problem in Côte d’Ivoire and Uganda were huge successes for the Trypa-NO! partnership. The next phase is critical in ensuring that these gains are sustained and we continue to drive towards elimination in other affected countries.”
Professor Joseph Ndung’u, Executive Director of FIND in Kenya, said: “We have never been closer ending this devastating disease, and we congratulate country leadership for their dedication and commitment to stamping it out. As these countries shift to cost-effective strategies that can not only achieve but also sustain disease elimination, we are also building an evidence base that can help inform elimination efforts in other countries and ensure that every last patient can be linked to treatment.”
The Trypa-NO! programme extension will start early this year and run for three years. Support from FIND towards elimination efforts in Angola and the DRC will continue until 2025.
Issued by APO Group on behalf of FIND