The battle against sleeping sickness, a disease that once ravaged Africa, is far from over. Despite remarkable progress, the quest to eliminate the disease entirely by 2030 remains a daunting challenge. This is the story of a groundbreaking initiative, STROGHAT, led by Dr. Elena Nicco, an epidemiologist at the Institute of Tropical Medicine (ITM) in Antwerp. The project aims to simplify treatment and eradicate the remaining cases of sleeping sickness in the Democratic Republic of the Congo (DRC).
A Complex History
Sleeping sickness, or gambiense human African trypanosomiasis (gHAT), is caused by a microscopic parasite transmitted through the bite of an infected tsetse fly. Once inside the body, it spreads through the blood and lymph, causing fever, headaches, and joint pain. Left untreated, it invades the brain and central nervous system, leading to confusion, muscle weakness, and disrupted sleep patterns, ultimately proving fatal. For decades, controlling the disease relied on labor-intensive village-to-village screening and treatment, which, while effective, was far from straightforward.
A New Treatment Approach
STROGHAT introduces a revolutionary strategy centered around acoziborole, a drug developed by the Drugs for Neglected Diseases initiative (DNDi). Acoziborole is a single-dose oral treatment, significantly simplifying the process compared to older, toxic intravenous treatments. This new approach, known as 'screen-and-treat', involves mobile teams testing people in their villages and treating those with positive screening tests. Samples are then sent to a laboratory for confirmation.
The trial's success is evident in the numbers. Two years into the study, almost 455,000 people have been screened, with only 0.43% showing antibodies indicating possible infection. Less than 10 of these were confirmed as true cases. Acoziborole has demonstrated 98.1% efficacy in clinical trials, allowing for the elimination of the need for lumbar punctures before treatment.
Building Trust and Community Engagement
The success of STROGHAT extends beyond scientific innovation. Researchers have worked closely with local authorities, village leaders, healthcare workers, and communities to build trust and ensure acceptance of the new screening and treatment methods. Dr. Charles Kambo, a field investigator, notes the enthusiastic response from communities, who have been devastated by sleeping sickness in the past.
The Road Ahead
The final year of the study will involve a large-scale prevalence survey across Nord Équateur, testing a representative sample to determine if transmission has genuinely stopped. If successful, this evidence could guide the DRC's national program and the WHO in deciding whether 'screen-and-treat' should become standard practice elsewhere. The project's progress is encouraging, and the potential for eradicating sleeping sickness is within reach, thanks to a combination of scientific innovation, persistent fieldwork, and community trust.
