Table 1.

Summary of Recommendations From Modeling for 4 Neglected Tropical Diseases Controlled Primarily by Intensified Disease Management

Disease	Current strategy	Key elimination strategies	Programmatic considerations
Gambiense sleeping sickness [34]	Active screening using mobile teams Passive detection in fixed health facilities	• Tsetse control using tiny targets to accelerate breaking transmission • Enhancing passive detection by increasing access to HAT diagnostics • Targeting high-risk groups and increasing turn-out in active screening	• Large-scale deployment and maintenance of targets in hard-to-reach regions • How to identify and target high-risk groups to screen
Visceral leishmaniasis in the Indian subcontinent [27]	4 phases of interventions: preparatory phase, 5-year attack phase with ACD and high-coverage IRS, ≥ 3-year consolidation phase with limited IRS and intensified ACD, maintenance phase to ensure elimination target sustained	• Adjust attack phase duration according to precontrol endemicity (eg, increase duration for high precontrol endemicity settings) • Carry out active case detection and treatment of PKDL cases • Include PKDL in elimination target	• As incidence decreases, the pool of susceptible individuals will grow, creating the potential for new large-scale outbreaks • Although potentially resource-saving, adjusting the attack phase duration by setting may be difficult to achieve in practice • Diagnosis of PKDL is challenging • An empirical threshold is required to include PKDL in the elimination target, and it is unclear what this should be
Chagas disease [36]	Vector control (indoor residual spraying) for domiciliated vectors	• Improve efficacy of vector control • Improve access to diagnosis and etiological treatment • Combine both strategies where feasible	• Efficacy and effectiveness of vector control is difficult to measure in practice • Sylvatic vectors will hardly be affected by indoor residual spraying of insecticides • Diagnosis and treatment of mother and child may help prevent congenital transmission, but in cases of chronic Chagas disease, treatment may be perceived as noncurative and hence not adhered to (although parasite clearance effected by treatment would reduce onward transmission and have a population impact)
Leprosy [32]	Passive case detection in local health- care facilities Active case detection in mobile facilities (eg, “skin camps”) Active case detection in high prevalence communities and households	• Earlier case detection (eg, better diagnostics, more active surveillance) • Targeted active surveillance and prophylatic chemotherapy (eg, identification of transmission “hot spots”)	• Stigma remains a substantial barrier to early diagnosis • Migration and movement (the long period between infection and disease makes movement important) • Diagnostic procedures and prophylactic chemotherapy both need development

Abbreviations: ACD, active case detection; HAT, human African trypanosomiasis; IRS, indoor residual spraying of insecticide; PKDL, post–kala azar dermal leishmaniasis.