{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:22:58Z","timestamp":1785536578114,"version":"3.56.0"},"update-to":[{"DOI":"10.12688\/gatesopenres.13070.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2020,4,21]],"date-time":"2020-04-21T00:00:00Z","timestamp":1587427200000}}],"reference-count":30,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2020,4,21]],"date-time":"2020-04-21T00:00:00Z","timestamp":1587427200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000266","name":"Engineering and Physical Sciences Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000266","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1184344"],"award-info":[{"award-number":["OPP1184344"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1177824"],"award-info":[{"award-number":["OPP1177824"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["gatesopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Gates Open Res"],"abstract":"<ns4:p>Gambiense human African trypanosomiasis (gHAT) is a parasitic, vector-borne neglected tropical disease that has historically affected populations across West and Central Africa and can result in death if untreated. Following from the success of recent intervention programmes against gHAT, the World Health Organization (WHO) has defined a 2030 goal of global elimination of transmission (EOT). The key proposed indicator to measure achievement of the goal is zero reported cases. Results of previous mathematical modelling and quantitative analyses are brought together to explore both the implications of the proposed indicator and the feasibility of achieving the WHO goal.<\/ns4:p>\n                  <ns4:p>Whilst the indicator of zero case reporting is clear and measurable, it is an imperfect proxy for EOT and could arise either before or after EOT is achieved. Lagging reporting of infection and imperfect diagnostic specificity could result in case reporting after EOT, whereas the converse could be true due to underreporting, lack of coverage, and cryptic human and animal reservoirs. At the village-scale, the WHO recommendation of continuing active screening until there are three years of zero cases yields a high probability of local EOT, but extrapolating this result to larger spatial scales is complex.<\/ns4:p>\n                  <ns4:p>Predictive modelling of gHAT has consistently found that EOT by 2030 is unlikely across key endemic regions if current medical-only strategies are not bolstered by improved coverage, reduced time to detection and\/or complementary vector control.\u00a0 Unfortunately, projected costs for strategies expected to meet EOT are high in the short term and strategies that are cost-effective in reducing burden are unlikely to result in EOT by 2030. Future modelling work should aim to provide predictions while taking into account uncertainties in stochastic dynamics and infection reservoirs, as well as assessment of multiple spatial scales, reactive strategies, and measurable proxies of EOT.<\/ns4:p>","DOI":"10.12688\/gatesopenres.13070.2","type":"journal-article","created":{"date-parts":[[2020,4,23]],"date-time":"2020-04-23T06:15:08Z","timestamp":1587622508000},"page":"1553","update-policy":"https:\/\/doi.org\/10.12688\/gatesopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":13,"title":["Insights from quantitative and mathematical modelling on the proposed 2030 goal for gambiense human African trypanosomiasis (gHAT)"],"prefix":"10.12688","volume":"3","author":[{"name":"NTD Modelling Consortium Discussion Group on Gambiense Human African 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Barrett, Wellcome Centre for Integrative Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK, 29 Oct 2019, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/gatesopenresearch.org\/articles\/3-1553\/v1#referee-response-27987","order":0,"name":"referee-response-27987","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Kat Rock<\/b>; \n<i>Posted: 02 Apr 2020<\/i>; Thank you for your helpful comments, we have added additional clarifications to the manuscript as recommended:  We agree we should be more careful with our wording in Table 1 about diagnostics. We have updated the text to: \u201cExisting diagnostics may be sufficient, based on currently reported diagnostic characteristics. However, (i) the indicator of zero reported cases does not imply that the goal of EOT has been reached,&nbsp; (ii) sensitivity could change based on future variation of circulating parasites, and (iii) new tools could improve throughput for large-scale, high-specificity surveillance and\/or the ability to detect cryptic human or animal reservoirs. \u201c To address the possibility for decreasing sensitivity of diagnostics we added in the \u201cZero reporting but not EOT\u201d section: \u201cChoice and use of available diagnostics are crucial for information certainly \u2013 as we approach the endgame it may be that current diagnostics become less able to detect circulating antibodies (due to changing parasite antigen expression) and therefore decrease sensitivity of surveillance tools.\u201d We discuss animal reservoirs primarily on page 6 (whilst mentioning them on page 5) so have now added a cross-reference \u201cand is discussed in more detail in the \u201cRisks and Unknowns\u201d section below.\u201d In that section we add a note on decreasing case trends increasing our optimism: \u201cThe observed decreasing human case trends combined with model fitting to such data provide optimism that there is limited, if any, transmission from non-human animals to humans (via tsetse), however the discovery of transmission cycles in dogs in the last phase of Guinea worm eradication programme (26) serves as an important reminder that the role of animals should not yet be completely discounted as we aim towards EOT for gHAT.\u201c You are correct that models can be used to predict cessation or removal of controls and we have now added the following: \u201cModelling can also simulate the possible impact of such future disruption to activities (planned or otherwise) in addition to more optimistic assumptions about intervention coverage. Whilst planned cessation following zero reporting has been already considered in some modelling studies (Davis, 2019), unplanned intervention suspension and its impact can and should be explored in future modelling work \u201c Firstly, we would like to emphasise that the cited cost-effectiveness study did utilise both a cost and transmission dynamic modeling framework, therefore it accounted for a decreasing burden as predicted by the transmission model for different interventions. (We have added a sentence to clarify this - \u201cCombining cost models with dynamic transmission models provides a valuable framework in which to examine the financial and economic impacts and the cost-effectiveness of strategies which account for changing burden as elimination is approached and\/or achieved. One such cost-effectiveness analysis\u2026\u201d) We also added some text on our ongoing work which highlights important analyses for providing updated and localised strategy recommendations although we believe the overall message will hold: \u201cOngoing work by the co-authors as part of the HAT Modelling and Economic Predictions for Policy (HAT MEPP) project seeks to assess the cost-effectiveness of elimination strategies based on recent, local data and model updates in order to provide specific and up-to-date recommendations across different settings. It is anticipated that, as before, recommended strategies will not be the same in different transmission settings or geographic regions and will depend on affordability and willingness to pay for averted DALYs or EOT.\u201d","URL":"https:\/\/gatesopenresearch.org\/articles\/3-1553\/v2#referee-comment-3306","order":1,"name":"referee-comment-3306","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/gatesopenres.14304.r28781, Mario Recker, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Penryn, UK, 23 Apr 2020, version 2, indexed","URL":"https:\/\/gatesopenresearch.org\/articles\/3-1553\/v2#referee-response-28781","order":2,"name":"referee-response-28781","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This work was supported by the Bill and Melinda Gates Foundation [OPP1184344, OPP1177824] through the NTD Modelling Consortium (KSR, MJK, MA, NC, SC) and the HAT Modelling and Economic Predictions for Policy (HAT MEPP) project (KSR, MJK, MA, FT, REC, CH). CND was funded by EPSRC\/MRC via the MathSys Centre for Doctoral Training. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}