Development and pilot application of a point-of-need molecular xenomonitoring protocol for tsetse (Glossina sp:) in a low-resource setting

Background: Tsetse flies (Glossina sp.) are the primary vectors of trypanosomes causing human African trypanosomiasis (HAT) and animal African trypanosomiasis (AAT). Disease surveillance can be carried out by detecting Trypanosoma DNA in tsetse, also known as molecular xenomonitoring. Whilst molecular methods can increase the efficiency and sensitivity of pathogen detection, trained staff and a well-equipped laboratory are required. In many cases, DNA extraction and screening is outsourced to a central laboratory in a major city either in-country or abroad, far removed from original tsetse collection sites. This increases results turnaround time, incurs transportation costs, and can lead to sample loss or damage. Methodology/Principle Findings: We set out to develop, optimise and trial methods for tsetse xenomonitoring in a low-resource point-of-need setting. A low-cost protocol was developed consisting of rapid alkali-based DNA extraction and Trypanosoma detection qPCR assays using air-dryable reagent mixes. A minimally-equipped laboratory was established in a field station in Arua, Uganda. Following a training workshop, three entomology technicians carried out screening on 286 tsetse collected over a nine-week study period. The technicians consistently extracted high quality DNA (98% success rate) and were able to successfully detect T. brucei sensu lato in 4.3% (95% confidence interval (CI) [2.23 - 7.37]), T. congolense in 3.6% (95% CI [1.73 – 6.47]) and T. vivax in 3.9% (95% CI [1.98 – 6.92]) of total tsetse, representing a total Trypanosoma sp detection prevalence of 10.7% (95% CI [9.6 – 11.8]). Conclusions/Significance: This study demonstrated that sensitive molecular xenomonitoring of HAT and AAT pathogens can be carried out without the need for cold-chain storage or high-powered equipment. Further improvements to the system might be achieved by modifying the DNA extraction protocol to enable high-throughput or pooled samples, increasing the sensitivity of the T. b. gambiense DNA detection assay and exploring more sustainable power sources. Author summary: Tsetse flies spread the parasitic diseases human African trypanosomiasis (sleeping sickness) and animal African trypanosomiasis (nagana) that impact populations across sub-Saharan Africa. Disease surveillance can be carried out using tests to detect parasite DNA in tsetse, termed molecular xenomonitoring. Currently, these methods are too complex, costly and logistically-challenging to be carried out in remote areas where sleeping sickness is a problem. However, advances in molecular testing technology are now making this a possibility. We set out to develop a tsetse molecular xenomonitoring system using a basic laboratory set-up in Arua, Uganda. The protocol comprised a low-cost method to extract DNA from tsetse, a portable qPCR machine to test samples and air-dried reagents that did not require cold storage. Following a two-week training workshop, three technicians went on to carry out testing on 286 tsetse over a nine-week period. The technicians were able to consistently extract high-quality DNA (98% success rate) and successfully detected trypanosome parasite DNA in 30 (10.7%) of these tsetse samples. Whilst there are still challenges to overcome, this study has demonstrated that molecular xenomonitoring of tsetse can be carried out without the need for trainees with previous molecular experience, refrigerated reagents or high-powered equipment.