Abstract
Background
Diagnosis and treatment are central elements of strategies to control Trypanosoma brucei gambiense human African trypanosomiasis (HAT). Serological screening is a key entry point in diagnostic algorithms. The Card Agglutination Test for Trypanosomiasis (CATT) has been the most widely used screening test for decades, despite a number of practical limitations that were partially addressed by the introduction of rapid diagnostic tests (RDTs). However, current RDTs are manufactured using native antigens, which are challenging to produce.
Methodology/Principal findings
The objective of this study was to evaluate the accuracy of a new RDT developed using recombinant antigens (SD BIOLINE HAT 2.0), in comparison with an RDT produced using native antigens (SD BIOLINE HAT) and CATT. A total of 57,632 individuals were screened in the Democratic Republic of the Congo, either passively at 10 health centres, or actively by 5 mobile teams, and 260 HAT cases were confirmed by parasitology. The highest sensitivity was achieved with the SD BIOLINE HAT 2.0 (71.2%), followed by CATT (62.5%) and the SD BIOLINE HAT (59.0%). The most specific test was CATT (99.2%), while the specificity of the SD BIOLINE HAT and SD BIOLINE HAT 2.0 were 98.9% and 98.1%, respectively. Sensitivity of the tests was lower than previously reported, as they identified cases from partially overlapping sub-populations. All three tests were significantly more sensitive in passive than in active screening. Combining two or three tests resulted in a markedly increased sensitivity: When the SD BIOLINE HAT was combined with the SD BIOLINE HAT 2.0, sensitivity reached 98.4% in passive and 83.0% in active screening.
Conclusions/Significance
The recombinant antigen-based RDT was more sensitive than, and as specific as, the SD BIOLINE HAT. It was as sensitive as, but slightly less specific than CATT. While the practicality and cost-effectiveness of algorithms including several screening tests would need to be investigated, using two or more tests appears to enhance sensitivity of diagnostic algorithms, although some decrease in specificity is observed as well.
Sleeping sickness, or human African trypanosomiasis (HAT), is a neglected tropical disease that represents a risk to more than seventy million people in Sub-Saharan Africa. Most cases are caused by infection with Trypanosoma brucei gambiense. Diagnosis of HAT relies on the identification of suspected cases by serological methods, which include recently developed rapid diagnostic tests (RDTs). Current RDTs are produced using native antigens that are purified from live parasites in a laborious and dangerous process. The objective of this study was to evaluate the performance of a new RDT made using recombinant antigens, by screening people in fifteen endemic sites in the Democratic Republic of the Congo. The new RDT was found to be more sensitive than, and as specific as, the reference RDT made using native antigens. It was also more sensitive than CATT, a serological test that has been widely used for decades. While one third of HAT cases were correctly diagnosed by all tests, the other cases were only identified by one or two of the tests. In order to enhance case detection and accelerate elimination of HAT, there may be a need to explore diagnostic strategies that combine two or more screening tests.
Collapse