Discussion

Bloodstream trypanosomes that cause Gambiense human African trypanosomiasis (HAT) evade the immune system by frequently changing their surface proteins. They cause a chronic disease without specific symptoms, and in advanced disease, invade the brain. These characteristics have for long made it difficult to develop vaccines, diagnostics and drugs, frustrating efforts to control the disease, and contributing to suffering of impoverished communities in resource-limited settings in Africa. Recent initiatives have exploited the unique biology of trypanosomes and tsetse fly vectors, and developed new tools for control of the disease. Cheap, instrument-free, rapid diagnostic tests (RDTs) targeting predominant and invariant antigens on the trypanosome surface have become available. The tests can be used for screening patients and communities in health facilities and villages where they live. Confirmation of disease has been improved by development of better, field-applicable microscopy and molecular methods. It is now easier and safer to treat HAT patients using a combination of nifurtimox and eflornithine. Implementation of these tools using novel strategies that include tsetse control is accelerating control of HAT, and increasing the prospects of its elimination. Sustaining these gains and maintaining the momentum towards the elimination goal requires committed funding, strong partnerships and coordination.