Elimination of gambiense human African trypanosomiasis as a public health problem in Republic of Guinea: Paving the way for zero transmission.

The Republic of Guinea has faced an important challenge with human African trypanosomiasis (HAT), which was endemic over the last century. After initial control in the 1960s-1970s, HAT resurged in the 1990s along the Guinean coast, driven by economic and demographic pressures on the mangrove ecosystem. In response, the Guinean government established a national control program in 2002, focusing on medical mass screenings. In 2012, vector control using tiny targets was introduced in the East Boffa focus to reduce fly density and human-vector contact. However, the Ebola epidemic from 2013 to 2016 disrupted these efforts, leading to a reliance on passive screening. Resuming screenings in 2016-2017 revealed increased cases in all foci except the East Boffa area, where vector control had been effective. Vector control continued during the SARS-CoV2 pandemic and at the same time targeted door-to-door screenings were introduced to target high-risk individuals. Since 2018, around 30,000 at-risk individuals have been screened annually. These strategies reduced the total number of new cases below 1 per 10,000 inhabitants in endemic areas over the period 2019-2023, allowing to validate the elimination of HAT as a public health problem. The Guinean team and partners then focused on systematic spatial monitoring of patients and community engagement in vector control. The program also integrates control of other neglected tropical diseases and addresses new research questions, especially about anatomical and animal reservoirs for parasites. These efforts, combined with implementation of improved diagnostic tests and new oral treatments, through active involvement in multiple clinical trials and studies, now aim to interrupt HAT transmission by 2030.