The WHO Department of Control of Neglected Tropical Diseases (NTD) manages a diverse portfolio of twenty diseases, each with its own unique challenges, including the diagnostic aspect. In order to identify and prioritize diagnostic needs, a WHO NTD Diagnostics Technical Advisory Group (DTAG) was formed, and a specific subgroup was created to advise on the human African trypanosomiasis (HAT) diagnostic innovation needs. The purpose of this TPP is to communicate the minimum and ideal characteristics desired to meet the need for a simpler and more performant test able to confirm an infection with Trypanosoma brucei gambiense, usable by non-specialised personnel in the context of disease elimination. The primary target audience is the potential developers of diagnostic tests and the potential donors that could provide funding for this tools that are considered priorities by the experts convened by WHO.
Concerted efforts by national programmes, supported by public–private partnerships, nongovernmental organizations, donors and academia under the auspices and coordination of the World Health Organization (WHO), have produced important achievements in the control of human African trypanosomiasis (HAT). As a consequence, the disease was targeted for elimination as a public health problem by 2020. The Sixty-sixth World Health Assembly endorsed this goal in resolution WHA66.12 on Neglected tropical diseases, adopted in 2013. National sleeping sickness control programmes (NSSCPs) are core to progressing in the control of the disease and in adapting to the different epidemiological situations. The involvement of different partners, as well as the support and trust of long-term donors, has been crucial for these achievements. More than 20 years of partnership among WHO, Sanofi and Bayer have enabled WHO to strengthen and sustain financial, technical and material support for the implementation of control activities in countries where HAT is endemic. The long-term support from the Government of Belgium, the Bill & Melinda Gates Foundation (BMGF) and other research institutions in the Democratic Republic of the Congo (DRC) has also been essential. WHO convened the fifth stakeholders meeting on the elimination of HAT due to infection with Trypanosoma brucei gambiense (g-HAT) and Trypanosoma brucei rhodesiense (r-HAT) in Geneva, Switzerland, on 7–9 June 2023. The meeting was held again in person after the coronavirus disease (COVID-19) pandemic and jointly for both forms of the disease. The previous meetings on g-HAT held in 2014, 2016 and 2018, as well as on r-HAT in 2015, 2017 and 2019, and jointly for g-HAT and r-HAT in 2021 (8) reinforced the partnership and commitment for HAT elimination and structured the mechanisms of collaboration within the WHO network for HAT elimination. The network includes NSSCPs, groups developing new tools, international and nongovernmental organizations involved in disease control, and donors. Fewer than 1000 cases of HAT annually have been reported over the past 5 years, which is a historic achievement. The area at risk has been substantially reduced. The elimination of HAT as a public health problem at the global level has been achieved. The new road map for neglected tropical diseases (NTDs) 2021−2030 (“the road map”) with the target to interrupt the transmission of g-HAT requires the strengthened and sustained efforts of all stakeholders, national authorities and partners, under WHO coordination. It will take disproportionally high efforts and innovative strategies to find the last cases of g-HAT and neutralize its transmission. Given the limited resources and other competing public health priorities, this is a challenge that requires our joint commitment.
The fifth meeting of the WHO Diagnostic Technical Advisory Group for Neglected Tropical Diseases (DTAG) was held in November 2022. The DTAG was established in 2019 to address gaps in NTD diagnostics through a harmonized approach for identifying and prioritizing diagnostic needs, and to inform WHO strategies and guidance on NTD diagnostics. The meeting addressed the end-to-end process of diagnostic development, including regulatory pathways, as we all as advocacy and resource mobilization, and engagement of diagnostics manufacturers and developers. The DTAG and its disease-specific and cross-cutting subgroups have supported and facilitated the development of several target product profiles for selected NTDs to address the critical diagnostic gaps.
The Global report on neglected tropical diseases 2023 provides a consolidated, up-to-date assessment of progress towards control, elimination and eradication of 20 diseases and disease groups (NTDs) globally, regionally and nationally. Progress is reported in the context of global commitments, strategies and targets set in the NTD road map 2021-2030. The document covers the first two years of implementation of the road map (2021 and 2022). The information presented is based primarily on epidemiological and programmatic data for interventions conducted in 2021 and gathered in 2022, but the report also describes a wide range of activities and accomplishments that were registered in both 2021 and 2022; comparisons are often made against 2020 and 2019 data, especially with regard to COVID-19 disruptions. It has four sections: Section 1 is an introduction. Section 2 presents the status of the global NTD response. Section 3 charts progress and developments against the three road map pillars. Section 4 sets out priority actions for 2023 and beyond to sustain implementation of the road map and its companion documents. Five annexes to the report provide information for 2021–2022 on regional progress (Annex 1), Weekly Epidemiology Record articles on NTDs (Annex 2), progress and challenges by disease (Annex 3), diagnostic target product profiles (Annex 4) and the status of commitments for donated medicines and health products (Annex 5).
Praise for the First Edition " . . . the book is a valuable addition to the literature in the field, serving as a much-needed guide for both clinicians and advanced students."—Zentralblatt MATH A new edition of the cutting-edge guide to diagnostic tests in medical research In recent years, a considerable amount of research has focused on evolving methods for designing and analyzing diagnostic accuracy studies. Statistical Methods in Diagnostic Medicine, Second Edition continues to provide a comprehensive approach to the topic, guiding readers through the necessary practices for understanding these studies and generalizing the results to patient populations. Following a basic introduction to measuring test accuracy and study design, the authors successfully define various measures of diagnostic accuracy, describe strategies for designing diagnostic accuracy studies, and present key statistical methods for estimating and comparing test accuracy. Topics new to the Second Edition include: Methods for tests designed to detect and locate lesions Recommendations for covariate-adjustment Methods for estimating and comparing predictive values and sample size calculations Correcting techniques for verification and imperfect standard biases Sample size calculation for multiple reader studies when pilot data are available Updated meta-analysis methods, now incorporating random effects Three case studies thoroughly showcase some of the questions and statistical issues that arise in diagnostic medicine, with all associated data provided in detailed appendices. A related web site features Fortran, SAS®, and R software packages so that readers can conduct their own analyses. Statistical Methods in Diagnostic Medicine, Second Edition is an excellent supplement for biostatistics courses at the graduate level. It also serves as a valuable reference for clinicians and researchers working in the fields of medicine, epidemiology, and biostatistics.
"The presence, or absence, of neglected tropical diseases (NTDs) can be seen as a proxy for poverty and for the success of interventions aimed at reducing poverty. Today, coverage of the public-health interventions recommended by the World Health Organization (WHO) against NTDs may be interpreted as a proxy for universal health coverage and shared prosperity - in short, a proxy for coverage against neglect. As the world's focus shifts from development to sustainable development, from poverty eradication to shared prosperity, and from disease-specific goals to universal health coverage, control of NTDs will assume an important role towards the target of achieving universal health coverage, including individual financial risk protection. Success in overcoming NTDs is a "litmus test" for universal health coverage against NTDs in endemic countries. The first WHO report on NTDs (2010) set the scene by presenting the evidence for how these interventions had produced results. The second report (2013) assessed the progress made in deploying them and detailed the obstacles to their implementation. This third report analyses for the first time the investments needed to achieve the scale up of implementation required to achieve the targets of the WHO Roadmap on NTDs and universal coverage against NTDs. INVESTING TO OVERCOME THE GLOBAL IMPACT OF NEGLECTED TROPICAL DISEASES presents an investment strategy for NTDs and analyses the specific investment case for prevention, control, elimination and eradication of 12 of the 17 NTDs. Such an analysis is justified following the adoption by the Sixty-sixth World Health Assembly in 2013 of resolution WHA6612 on neglected tropical diseases, which called for sufficient and predictable funding to achieve the Roadmap's targets and sustain control efforts. The report cautions, however, that it is wise investment and not investment alone that will yield success. The report registers progress and challenges and signals those that lie ahead. Climate change is expected to increase the spread of several vector-borne NTDs, notably dengue, transmission of which is directly influenced by temperature, rainfall, relative humidity and climate variability primarily through their effects on the vector. Investments in vector-borne diseases will avoid the potentially catastrophic expenditures associated with their control. The presence of NTDs will thereby signal an early warning system for climate-sensitive diseases. The ultimate goal is to deliver enhanced and equitable interventions to the most marginalized populations in the context of a changing public-health and investment landscape to ensure that all peoples affected by NTDs have an opportunity to lead healthier and wealthier lives."--Publisher's description.
Human African Trypaniosomiasis (HAT) or sleeping sickness is an old disease to be now considered as reemergent. HAT is endemic in 36 sub-Saharan African countries, in areas where tsetse flies are found. The public health importance of HAT is underestimated, but the disease causes severe social disruption in many rural areas. Along the past fifteen years, numerous studies were made, and now, the mechanisms involved in the disease pathogenesis and in the characteristics of sleep-wake disruption become to be better understood. But, since 50 years, when current drugs were introduced, problems regarding HAT chemotherapy have not been solved. Nevertheless, in-depth studies about trypanosome metabolism have permitted to discover new drug targets. Written by specialists who are very experienced in their respective fields, the contributions provide an indispensable tool for practitioners and scientists.
The Disease Reference Group on Chagas Disease Human AfricanTrypanosomiasis and Leishmaniasis (DRG3) was part of an independent thinktankof international experts established by the Special Programme for Researchand Training in Tropical Diseases (TDR) to identify key research prioritiesthrough systematic review of research evidence and input from stakeholders. These three distinct insect-borne diseases while caused by related kinetoplastidprotozoan pathogens have dissimilar geographical distributions a reflection oftheir different insect vectors and range of vector contact with humans. Thedisease.
Human African trypanosomiasis (HAT), or sleeping sickness, is a parasitic infection that is almost invariably fatal unless treated. It is a neglected tropical disease that occurs in sub-Saharan Africa. The incidence of the disease is declining in response to intensive surveillance and control in endemic areas. As a result, HAT is among the neglected tropical diseases targeted by the World Health Organization (WHO) for elimination. WHO maintains exhaustive records of all declared cases; in 2018, a historically low number of cases (less than 1000) was reported. The remarkable progress in the control of gambiense HAT has relied on case-finding and curative treatment, a strategy that interrupts transmission by depleting the reservoir of parasites in humans. This has been combined occasionally with vector control activities. The subject of these guidelines, therefore, is of utmost importance for the continuation of progress to eliminate HAT. The recent approval of a new medicine (fexinidazole) for the treatment of gambiense HAT has opened new possibilities for the management of cases and thus warrants the new WHO recommendations contained herein. While studies of fexinidazole and other therapies are ongoing, these guidelines are considered interim guidelines until new information becomes available. This document focuses on the management of patients affected by gambiense HAT and constitutes an update to the WHO therapeutic guidance issued in 2013.
