The cost of sleeping sickness vector control in the Democratic Republic of the Congo

Gambian human African trypanosomiasis (gHAT), a neglected tropical disease caused by a parasite transmitted by tsetse flies, once inflicted over 30,000 annual cases and resulted in half a million deaths in the late twentieth century. An international gHAT control program has reduced cases to under 1,000 annually, encouraging the World Health Organization to target the elimination of gHAT transmission by 2030. This requires adopting innovative disease control approaches in foci where transmission persists. Since the last decade, case detection and treatment, the mainstay of controlling the disease, is supplemented by vector control using Tiny Targets, small insecticide-treated screens, which attract and kill tsetse. The advantages of Tiny Targets lie in their relatively low cost, easy deployment, and effectiveness. The Democratic Republic of Congo (DRC), bearing 65% of the 799 gHAT cases reported globally in 2022, introduced Tiny Targets in 2015. This study estimates the annual cost of vector control using Tiny Targets in a health district in the DRC and identifies the main cost drivers. Economic and financial costs, collected from the providers perspective, were used to estimate the average cost of tsetse control expressed as cost (i) per target used, (ii) per target deployed, (iii) linear kilometre of river controlled, and (iv) square kilometres protected by vector control. Sensitivity analyses were conducted on key parameters for results robustness. The estimated annual economic cost for protecting an area of 1,925 km{superscript 2} was 120,000 USD. This translates to 5.3 USD per target used each year, 11 USD per target deployed in the field, 573 USD per linear km treated, and 62 USD per km{superscript 2} protected. These costs in the DRC are comparable to those in other countries. The study provides valuable information for practitioners and policymakers aiding them in making rational, evidence-based decisions regarding cost-effective strategies to control gHAT. Author SummaryIn the fight against Gambian human African trypanosomiasis (gHAT), a devastating disease transmitted by tsetse flies, significant progress has been made through international efforts. Despite the annual cases being reduced to under 1,000, the World Health Organization aims to eliminate gHAT transmission by 2030. A key component of this strategy involves innovative approaches, such as the use of Tiny Targets - small, cost-effective, insecticide-treated screens that attract and kill tsetse flies. This study focuses on the Democratic Republic of Congo (DRC), which bears a substantial burden of gHAT cases, estimating the annual cost of vector control using Tiny Targets in a specific health district. The analysis, conducted from the providers perspective, reveals an annual economic cost of 120,000 USD for protecting a 1,925 km{superscript 2} area. This translates to 5.3 USD per target used, 11 USD per target deployed, 573 USD per linear km treated, and 62 USD per km{superscript 2} protected. These findings, comparable to costs in other countries, offer valuable insights for practitioners and policymakers, guiding evidence-based decisions on cost-effective strategies for gHAT control.