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Longbottom, J.

Publications and source records attributed to Longbottom, J..

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Impact of a national tsetse control programme to eliminate Gambian sleeping sickness in Uganda: a spatio-temporal modelling study.

IntroductionTsetse flies (Glossina) transmit Trypanosoma brucei gambiense which causes gambiense human African trypanosomiasis (gHAT). As part of national efforts to eliminate gHAT as a public health problem, Uganda implemented a large-scale programme of deploying Tiny Targets, which comprise panels of insecticide-treated material which attract and kill tsetse. At its peak, the programme was the largest tsetse control operation in Africa. Here, we quantify the impact of Tiny Targets and environmental changes on the spatial and temporal patterns of tsetse abundance across north-western Uganda. MethodsWe leverage a 100-month longitudinal dataset detailing Glossina fuscipes fuscipes catches from monitoring traps between October 2010 and December 2019 within seven districts in north-western Uganda. We fitted a boosted regression tree model assessing environmental suitability which was used alongside Tiny Target data to fit a spatio-temporal geostatistical model predicting tsetse abundance across our study area ([~]16,000 km2). We used the spatio-temporal model to quantify the impact of Tiny Targets and environmental changes on the distribution of tsetse, alongside metrics of uncertainty. ResultsEnvironmental suitability across the study area remained relatively constant over time, with suitability being driven largely by elevation and distance to rivers. By performing a counterfactual analysis using the fitted spatio-temporal geostatistical model we show that deployment of Tiny Targets across an area of 4000 km2 reduced the overall abundance of tsetse to low levels (median daily catch = 1.1 tsetse/trap, IQR = 0.85-1.28) with no spatial-temporal locations having high (>10 tsetse/trap/day) numbers of tsetse compared to 18% of locations for the counterfactual. ConclusionsIn Uganda, Tiny Targets reduced the abundance of G. f. fuscipes and maintained tsetse populations at low levels. Our model represents the first spatio-temporal model investigating the effects of a national tsetse control programme. The outputs provide important data for informing next steps for vector-control and surveillance. Key questionsO_ST_ABSWhat is already known on this topic?C_ST_ABSSmall panels of insecticide-treated fabric, called Tiny Targets, are used to attract, and kill riverine tsetse, the vectors of T. b. gambiense which causes gambiense human African trypanosomiasis (gHAT). In large-scale (250-2000 km2) trials conducted in five countries, deployment of Tiny Targets reduced the densities of tsetse by between 60 and >90%. What this study addsWe report an analysis of, and data from, a large-scale ([~]4,000km2) national tsetse control programme, implemented in Uganda to eliminate gHAT as a public health problem. We found that Tiny Targets reduced tsetse abundance across the study period (2011-2019) and maintained densities at low (<1 tsetse/trap/day) levels. We produce maps which detail spatial variances in tsetse abundance in response to vector control. How this study might affect research, practice, or policyIn 2022, Uganda received validation from the World Health Organisation (WHO) that it had eliminated gHAT as a public health problem. The large-scale deployment of Tiny Targets contributed to this achievement. Our findings provide evidence that Tiny Targets are an important intervention for other countries aiming to eliminate gHAT.

ecology↗

Optimising passive surveillance of a neglected tropical disease in the era of elimination: A modelling study

BackgroundSurveillance is an essential component of global programs to eliminate infectious diseases and avert epidemics of (re-)emerging diseases. As the numbers of cases decline, costs of treatment and control diminish but those for surveillance remain high even after the last case. Reducing surveillance may risk missing persistent or (re-)emerging foci of disease. Here, we use a simulation-based approach to determine the minimal number of passive surveillance sites required to ensure maximum coverage of a population at-risk (PAR) of an infectious disease. Methodology and Principal FindingsFor this study, we use Gambian human African trypanosomiasis (g-HAT) in north-western Uganda, a neglected tropical disease (NTD) which has been reduced to historically low levels (<1000 cases/year globally), as an example. To quantify travel time to diagnostic facilities, a proxy for surveillance coverage, we produced a high spatial-resolution resistance surface and performed cost-distance analyses. We simulated travel time for the PAR with different numbers (1-170) and locations (170,000 total placement combinations) of diagnostic facilities, quantifying the percentage of the PAR within 1h and 5h travel of the facilities, as per in-country targets. Our simulations indicate that a 70% reduction (51/170) in diagnostic centres still exceeded minimal targets of coverage even for remote populations, with >95% of a total PAR of ~3million individuals living [&le;]1h from a diagnostic centre, and we demonstrate an approach to best place these facilities, informing a minimal impact scale back. ConclusionsOur results highlight that surveillance of g-HAT in north-western Uganda can be scaled back without substantially reducing coverage of the PAR. The methodology described can contribute to cost-effective and equable strategies for the surveillance of NTDs and other infectious diseases approaching elimination or (re-)emergence. Author SummaryDisease surveillance systems are an essential component of public health practice and are often considered the first line in averting epidemics for (re-)emerging diseases. Regular evaluation of surveillance systems ensures that they remain operating at maximum efficiency; systems that survey diseases of low incidence, such as those within elimination settings, should be simplified to reduce the reporting burden. A lack of guidance on how to optimise disease surveillance in an elimination setting may result in added expense, and/or the underreporting of disease. Here, we propose a framework methodology to determine systematically the optimal number and placement of surveillance sites for the surveillance of infectious diseases approaching elimination. By utilising estimates of geographic accessibility, through the construction of a resistance surface and a simulation approach, we identify that the number of operational diagnostic facilities for Gambian human African trypanosomiasis in north-western Uganda can be reduced by 70% with a minimal reduction in existing coverage, and identify the minimum number of facilities required to meet coverage targets. Our analysis can be used to inform the number and positioning of surveillance sites for diseases within an elimination setting. Passive surveillance becomes increasingly important as cases decline and active surveillance becomes less cost-effective; methods to evaluate how best to engage this passive surveillance capacity given facility capacity and geographic distribution are pertinent for several NTDs where diagnosis is complex. Not only is this a complicated research area for diseases approaching elimination, a well-designed surveillance system is essential for the detection of emerging diseases, with this work being topical in a climate where emerging pathogens are becoming more commonplace.

pathology↗

Modelling the impact of climate change on the distribution and abundance of tsetse in Northern Zimbabwe

Background Climate change is predicted to impact the transmission dynamics of vector-borne diseases. Tsetse flies (Glossina) transmit species of Trypanosoma that cause human and animal African trypanosomiasis. A previous modelling study showed that temperature increases between 1990 and 2017 can explain the observed decline in abundance of tsetse at a single site in the Mana Pools National Park of Zimbabwe. Here, we apply a mechanistic model of tsetse population dynamics to predict how increases in temperature may have changed the distribution and relative abundance of Glossina pallidipes across northern Zimbabwe.Methods Local weather station temperature measurements were previously used to fit the mechanistic model to longitudinal G. pallidipes catch data. To extend the use of the model, we converted MODIS land surface temperature to air temperature, compared the converted temperatures with available weather station data to confirm they aligned, and then re-fitted the mechanistic model using G. pallidipes catch data and air temperature estimates. We projected this fitted model across northern Zimbabwe, using simulations at a 1 km × 1 km spatial resolution, between 2000 to 2016.Results We produce estimates of relative changes in G. pallidipes mortality, larviposition, emergence rates and abundance, for northern Zimbabwe. Our model predicts decreasing tsetse populations within low elevation areas in response to increasing temperature trends during 2000-2016. Conversely, we show that high elevation areas (>1000 M.A.S.L), previously considered too cold to sustain tsetse, may now be climatically suitable.Conclusions The results of this research represent the first regional-scale assessment of temperature related tsetse population dynamics, and the first high spatial-resolution estimates of this metric for northern Zimbabwe. Our results suggest that tsetse abundance may have declined across much of the Zambezi valley in response to changing climatic conditions during the study period. Future research including empirical studies is planned to improve model accuracy and validate predictions for other field sites in Zimbabwe.Competing Interest StatementThe authors have declared no competing interest.View Full Text

ecology↗

Quantifying geographic accessibility to improve cost-effectiveness of entomological monitoring.

BackgroundVector-borne diseases are important causes of mortality and morbidity in humans and livestock, particularly for poorer communities and countries in the tropics. Large-scale programs against these diseases, for example malaria, dengue and African trypanosomiasis, include vector control, and assessing the impact of this intervention requires frequent and extensive monitoring of disease vector abundance. Such monitoring can be expensive, especially in the later stages of a successful program where numbers of vectors and cases are low. Methodology/Principal FindingsWe developed a system that allows the identification of monitoring sites where pre-intervention densities of vectors are predicted to be high, and travel cost to sites is low, highlighting the most efficient locations for longitudinal monitoring. Using remotely sensed imagery and an image classification algorithm, we mapped landscape resistance associated with on- and off-road travel for every gridded location (3m and 0.5m grid cells) within Koboko district, Uganda. We combine the accessibility surface with pre-existing estimates of tsetse abundance and propose a stratified sampling approach to determine the most efficient locations for longitudinal data collection. Our modelled predictions were validated against empirical measurements of travel-time and existing maps of road networks. We applied this approach in northern Uganda where a large-scale vector control program is being implemented to control human African trypanosomiasis, a neglected tropical disease (NTD) caused by trypanosomes transmitted by tsetse flies. Our accessibility surfaces indicate a high performance when compared to empirical data, with remote sensing identifying a further ~70% of roads than existing networks. Conclusions/SignificanceBy integrating such estimates with predictions of tsetse abundance, we propose a methodology to determine the optimal placement of sentinel monitoring sites for evaluating control programme efficacy, moving from a nuanced, ad-hoc approach incorporating intuition, knowledge of vector ecology and local knowledge of geographic accessibility, to a reproducible, quantifiable one. Author SummaryAssessing the impact of vector control programmes requires longitudinal measurements of the abundance of insect vectors within intervention areas. Such monitoring can be expensive, especially in the later stages of a successful program where numbers of vectors and cases of disease are low. Efficient monitoring involves a prior selection of monitoring sites that are easy to reach and produce rich information on vector abundance. Here, we used image classification and cost-distance algorithms to produce estimates of accessibility within Koboko district, Uganda, where vector control is contributing to the elimination of sleeping sickness, a neglected tropical disease (NTD). We combine an accessibility surface with pre-existing estimates of tsetse abundance and propose a stratified sampling approach to determine locations which are associated with low cost (lowest travel time) and potential for longitudinal data collection (high pre-intervention abundance). Our method could be adapted for use in the planning and monitoring of tsetse- and other vector-control programmes. By providing methods to ensure that vector control programmes operate at maximum efficiency, we can ensure that the limited funding associated with some of these NTDs has the largest impact.

ecology↗