New diagnostics and treatment offer new hope for sleeping sickness but who will use them?

National control activities crippled by lack of sustainable funding

Advances in the development of new diagnostic tests and treatment bode well for the fight against human African trypanosomiasis (HAT), however, national control activities on the ground are crippled by a lack of sustainable funding, warns Médecins Sans Frontières (MSF).

HAT, or sleeping sickness as it is commonly known, is transmitted by the bite of the tsetse fly and is fatal if untreated. It affects some of the world’s poorest people living in remote rural areas throughout sub Saharan Africa; an estimated 70 million people are still at risk of contracting it. After years of neglect, the tide could be about to turn with two new rapid screening tests expected next year, and one new oral treatment in clinical trial. Yet efforts to move forward are at risk due to a lack of resources for national control activities.

“Today we face huge challenges medically and logistically. Highly qualified staff are needed to do a screening along with sensitive laboratory equipment, all of which must be transported to remote rural places, many affected by ongoing conflicts. New, better adapted tools will help simplify the process which is good for both patients and medical staff to better tackle the disease burden”, says Dr Anja De WEGGHELEIRE, Medical Coordinator at MSF in Kinshasa. “However, just when a united effort is most needed, national control activities are left under-funded and under-resourced. If this does not urgently change, we could lose the opportunity to diagnose and treat people who are not currently being reached and, worse, we risk a resurgence of the disease”.

In the Democratic Republic of Congo (DRC), home to three-quarters of all reported cases, the number of people tested for the disease has declined significantly in recent months. And in June 2013, the main source of external funding for the control programme is due to end. Without control mechanisms in place, the country risks seeing a resurgence of sleeping sickness, as has occurred several times in the past when monitoring significantly decreased, even for just short periods of time. If so, DRC may quickly find itself in a state similar to its neighbours, Central African Republic and South Sudan, where national control activities are extremely limited.

As the new dipstick tests expected in 2013, developed with the support of the Foundation for New Innovative Diagnostics  and the Institute of Tropical Medicine Antwerp respectively, are easy-to-use and do not require cold chain, more people at risk of the disease could be reached for screening. Even though other complicated tests will still be required to confirm suspected cases of infection, new screening tests will remove many of the logistical constraints faced today by mobile HAT teams. And the new oral drug developed with the support of Drugs for Neglected Diseases initiative (DNDi), fexinidazole, which is entering a phase 2/3 clinical trial (testing in field conditions), could, in the near future, offer a good alternative to the current multiple infusions required to treat advanced sleeping sickness.  

“If sustainable funding is not secured soon, the near future will see us with excellent new tools to tackle sleeping sickness, yet no national activities to implement them” warns Dr Manica BALASEGARAM, Executive Director of the MSF Access Campaign, “The coming months will be decisive in overcoming the uncertainties we now face in tackling sleeping sickness in DRC and other endemic countries where sustainable funding and adequate resources are urgently needed”.

MSF activities
Since 1986, MSF has screened more than 3 million people for HAT and treated more than 50,000 patients. MSF runs ongoing HAT programmes in South Sudan, CAR, and Democratic Republic of Congo.  MSF recently setup an international mobile HAT team to tackle sleeping sickness. To date, MSF’s international mobile HAT team has worked in Central African Republic (CAR), Chad, Republic of Congo, South Sudan and will soon work in Democratic Republic of Congo.