02175nas a2200205 4500000000100000008004100001260003400042653003200076100001400108700001500122700001300137700001200150700001200162700001400174700001300188245010600201856026000307520137700567022002501944 2019 d bOxford University Press (OUP)10aVisceral leishmaniasis (VL)1 aCoffeng L1 aLe Rutte E1 aMuñoz J1 aAdams E1 aPrada J1 ade Vlas S1 aMedley G00aImpact of Changes in Detection Effort on Control of Visceral Leishmaniasis in the Indian Subcontinent uhttps://watermark.silverchair.com/jiz644.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAnAwggJsBgkqhkiG9w0BBwagggJdMIICWQIBADCCAlIGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMwrszaSYD6ms6gLR3AgEQgIICI8yfoNHGKqG2UgaePyYrdxCjSe3-QgHxtIGuqMKQLneOY7933 aBackground
Control of visceral leishmaniasis (VL) on the Indian subcontinent relies on prompt detection and treatment of symptomatic cases. Detection efforts influence the observed VL incidence and how well it reflects the underlying true incidence. As control targets are defined in terms of observed cases, there is an urgent need to understand how changes in detection delay and population coverage of improved detection affect VL control.

Methods
Using a mathematical model for transmission and control of VL, we predict the impact of reduced detection delays and/or increased population coverage of the detection programs on observed and true VL incidence and mortality.

Results
Improved case detection, either by higher coverage or reduced detection delay, causes an initial rise in observed VL incidence before a reduction. Relaxation of improved detection may lead to an apparent temporary (1 year) reduction in VL incidence, but comes with a high risk of resurging infection levels. Duration of symptoms in detected cases shows an unequivocal association with detection effort.

Conclusions
VL incidence on its own is not a reliable indicator of the performance of case detection programs. Duration of symptoms in detected cases can be used as an additional marker of the performance of case detection programs. a0022-1899, 1537-6613