# Control of Human African Trypanosomiasis in the Nola‐Bilolo Focus, Central African Republic, 2020–2024: Outcome of Capacity Building, Improved Diagnosis and Treatment

## TL;DR

This study evaluates improved diagnosis and treatment methods for human African trypanosomiasis in the Central African Republic, showing increased case detection and treatment access.

## Contribution

The study demonstrates the effectiveness of mAECT and fexinidazole in improving HAT diagnosis and treatment in CAR.

## Key findings

- mAECT detected trypanosomes in 87.88% of cases, compared to 48.48% with CTC.
- Fexinidazole was used to treat 72.41% of confirmed HAT cases with no treatment interruptions.
- The introduction of new methods increased reported HAT cases from 45 in 2021 to 111 in 2024.

## Abstract

This study is aimed at evaluating the inclusion of miniature anion‐exchange centrifugation technique (mAECT) in the diagnosis and fexinidazole as treatment of gHAT in Central African Republic (CAR) after capacity building. A cross‐sectional pilot study was conducted during a mass diagnostic campaign from 16 September to 22 October 2022 in Nola‐Bilolo, a historic focus in CAR. The serological test, card agglutination test for trypanosomiasis (CATT), was performed on whole blood and diluted plasma to screen participants, followed by a confirmatory parasitological test by capillary tube centrifugation (CTC) and mAECT. Positive cases were treated mainly with fexinidazole. A total of 2070 participants were screened, out of an estimated population of 3584, representing a participation rate of 58%. The seroprevalence of HAT was 1.6% (CI 95%: 77%–99%) (33/2070) by the CATT plasma end‐dilution titre ≥ 1:16. Blood from serological subjects was examined microscopically after concentration by CTC and mAECT was positive for trypanosomes in 48.48% (CI 95%: 31%–66%) (16/33) and 87.88% (CI 95%: 77%–99%) (29/33) of cases, respectively. The prevalence of microscopically confirmed HAT was 0.77% (CI 95%: 0.40%–1.15%) and 1.4% (CI 95%: 1%–2%) by CTC and mAECT, respectively. Twenty‐one (72.41%) patients were treated with fexinidazole with a 0% interruption rate. The introduction of fexinidazole (2021) and mAECT (2022) likely contributed to the rise in reported cases (from 45 in 2021 to 111 in 2024) and improved screening coverage in the study area, reflecting enhanced case detection and access to care. There is a necessity to establish diagnostic quality assurance and to reinforce the other control measures including vector control.