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    • To facilitate WHO s goals it is important to

    2019-04-22

    To facilitate WHO\'s goals, it Cy3 hydrazide is important to assess the cost-effectiveness of interventions that incorporate emerging technologies for case detection, treatment, and vector control in the context of economic constraints and logistical barriers. In an elegant modelling study in , Simone Sutherland and colleagues evaluated the cost-effectiveness of synergistic and progressively available approaches. To account for heterogeneity in tsetse exposure and the role of animal reservoirs, strategies were investigated in the context of varying disease dynamics and transmission intensities that characterise a range of settings. Their analyses indicated that, although several strategy combinations have the potential to achieve elimination goals, only approaches that incorporate emerging diagnostic, treatment, and vector control technologies are cost-effective. More specifically, their findings suggested that current control methods comprised exclusively of passive and active case-finding followed by treatment are not cost-effective options relative to strategies that include vector control with improved insecticide-impregnated screens, mobile teams with rapid diagnostic methods, and next-generation treatment regimens. Over the past decade, the incidence of human African trypanosomiasis caused by has dropped by more than 75%, down to fewer than 4000 reported cases a year. Nonetheless, an estimated 70 million people across 35 countries remain at risk of infection, and incidence is thought to be widely under-reported. Among regions at risk of human African trypanosomiasis caused by , 62% are currently low transmission areas. Sutherland and colleagues found that strategies most likely to meet elimination goals are not cost-effective in areas of low transmission, highlighting the effect of variations in transmission intensities across settings on the cost-effectiveness of control efforts. Heterogeneity in incidence between settings arises from variable tsetse density, distributions in human exposure to tsetse, animal reservoirs, compliance with active screening, and under-reporting. The effect of variation in these factors should be considered with respect to the optimality of alternative strategies in specific settings. For example, strategies most likely to achieve elimination in areas such as Bipindi, Cameroon, where livestock are an important disease reservoir, might be different in settings including Boffa, Guinea, where livestock have a small role. As a result, the cost-effectiveness of tailored and localised recommendations will have greater use in facilitating elimination than will broad guidance. We should also bear in mind that, as incidence declines, handling of remaining cases becomes disproportionately costly and challenging. Further studies ribosomes capture the long-term benefits of eradication, including the reduced monetary commitment and, most importantly, averted health burden for future generations, will be fundamental to assessing the indirect benefits and the positive externalities of achieving and sustaining elimination. Progress towards WHO\'s goals for 2020 and 2030 must be paralleled with a shift in focus towards identifying optimum control strategies to maintain elimination, as shown by the history of control efforts for human African trypanosomiasis caused by . Through a combination of vector control and active and passive case-finding for early detection and rapid treatment of cases, human African trypanosomiasis caused by was near eradicated in the early 1960s. Unfortunately, a collapse of surveillance and monitoring activities in endemic countries, primarily originating from political instability, led to re-emergence of the disease in the early 1990s. The cost-effectiveness framework developed by Sutherland and colleagues for human African trypanosomiasis is a powerful method for informing a more effective endgame strategy. For example, to mitigate the possibility of resurgence, evaluation of the cost-effectiveness of surveillance methods to maintain elimination status across settings and assessment of the value of dedicating resources for post-elimination efforts will be important.