title: Decentralized control of human visceral leishmaniasis in endemic urban areas of Brazil: a literature review.
abstract: OBJECTIVE
  Human migration and concomitant HIV infections are likely to bring about major changes in the epidemiology of some parasitic infections in Brazil. Human visceral leishmaniasis (HVL) control is particularly fraught with intricacies. It is against a backdrop of decentralized health care that the complex HVL control initiatives are brought to bear. This comprehensive review aims to explore the obstacles facing decentralized HVL control in urban endemic areas in Brazil.
  
  
  METHODS
  A literature search was carried out in December 2015 by means of three databases: MEDLINE, Google Scholar, and Web of Science.
  
  
  RESULTS
  Although there have been many strides that have been made in elucidating the eco-epidemiology of Leishmania infantum, which forms the underpinnings of the national control program, transmission risk factors for HVL are still insufficiently elucidated in urban settings. Decentralized HVL epidemiological surveillance and control for animal reservoirs and vectors may compromise sustainability. In addition, it may hamper timely human HVL case management. With the burgeoning of the HIV-HVL co-infection, the potential human transmission may be underestimated.
  
  
  CONCLUSIONS
  HVL is a disease with focal transmission at a critical juncture, which warrants that the bottlenecks facing the control program within contexts of decentralized healthcare systems be taken into account. In addition, HIV-driven HVL epidemics may substantially increase the transmission potential of the human reservoir. Calculating the basic reproductive number to fine-tune interventions will have to take into consideration the specific socio-economic development context.
authors.affiliation: International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 P3, 9000 Ghent, Belgium ; Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada.
authors.forename: Sonia S
authors.initials: SS
authors.lastname: Menon
authors.affiliation: LSHTM alumni, Beirut, Lebanon.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Rossi
authors.affiliation: Department of Social and Preventive Medicine, Laval University, Boston, USA.
authors.forename: Leon
authors.initials: L
authors.lastname: Nshimyumukiza
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, MA USA.
authors.forename: Kate
authors.initials: K
authors.lastname: Zinszer
keywords: Basic reproductive number; Control and prevention; Decentralization; HIV; HIV co-infection; Human reservoir; Human visceral leishmaniasis; Visceral leishmaniasis