In:
PLOS Neglected Tropical Diseases, Public Library of Science (PLoS), Vol. 17, No. 5 ( 2023-5-17), p. e0011071-
Abstract:
Soil-transmitted helminth (STH) control programs currently lack evidence-based recommendations for cost-efficient survey designs for monitoring and evaluation. Here, we present a framework to provide evidence-based recommendations, using a case study of therapeutic drug efficacy monitoring based on the examination of helminth eggs in stool. Methods We performed an in-depth analysis of the operational costs to process one stool sample for three diagnostic methods (Kato-Katz, Mini-FLOTAC and FECPAK G2 ). Next, we performed simulations to determine the probability of detecting a truly reduced therapeutic efficacy for different scenarios of STH species ( Ascaris lumbricoides , Trichuris trichiura and hookworms), pre-treatment infection levels, survey design (screen and select ( SS ); screen, select and retest ( SSR ) and no selection ( NS )) and number of subjects enrolled (100–5,000). Finally, we integrated the outcome of the cost assessment into the simulation study to estimate the total survey costs and determined the most cost-efficient survey design. Principal findings Kato-Katz allowed for both the highest sample throughput and the lowest cost per test, while FECPAK G2 required both the most laboratory time and was the most expensive. Counting of eggs accounted for 23% (FECPAK G2 ) or ≥80% (Kato-Katz and Mini-FLOTAC) of the total time-to-result. NS survey designs in combination with Kato-Katz were the most cost-efficient to assess therapeutic drug efficacy in all scenarios of STH species and endemicity. Conclusions/significance We confirm that Kato-Katz is the fecal egg counting method of choice for monitoring therapeutic drug efficacy, but that the survey design currently recommended by WHO ( SS ) should be updated. Our generic framework, which captures laboratory time and material costs, can be used to further support cost-efficient choices for other important surveys informing STH control programs. In addition, it can be used to explore the value of alternative diagnostic techniques, like automated egg counting, which may further reduce operational costs. Trial Registration ClinicalTrials.gov NCT03465488
Type of Medium:
Online Resource
ISSN:
1935-2735
DOI:
10.1371/journal.pntd.0011071
DOI:
10.1371/journal.pntd.0011071.g001
DOI:
10.1371/journal.pntd.0011071.g002
DOI:
10.1371/journal.pntd.0011071.g003
DOI:
10.1371/journal.pntd.0011071.g004
DOI:
10.1371/journal.pntd.0011071.g005
DOI:
10.1371/journal.pntd.0011071.g006
DOI:
10.1371/journal.pntd.0011071.t001
DOI:
10.1371/journal.pntd.0011071.t002
DOI:
10.1371/journal.pntd.0011071.t003
DOI:
10.1371/journal.pntd.0011071.t004
DOI:
10.1371/journal.pntd.0011071.s001
DOI:
10.1371/journal.pntd.0011071.s002
DOI:
10.1371/journal.pntd.0011071.s003
DOI:
10.1371/journal.pntd.0011071.s004
DOI:
10.1371/journal.pntd.0011071.s005
DOI:
10.1371/journal.pntd.0011071.s006
DOI:
10.1371/journal.pntd.0011071.s007
DOI:
10.1371/journal.pntd.0011071.s008
DOI:
10.1371/journal.pntd.0011071.s009
DOI:
10.1371/journal.pntd.0011071.s010
DOI:
10.1371/journal.pntd.0011071.s011
DOI:
10.1371/journal.pntd.0011071.s012
DOI:
10.1371/journal.pntd.0011071.s013
DOI:
10.1371/journal.pntd.0011071.s014
DOI:
10.1371/journal.pntd.0011071.s015
DOI:
10.1371/journal.pntd.0011071.s016
DOI:
10.1371/journal.pntd.0011071.r001
DOI:
10.1371/journal.pntd.0011071.r002
DOI:
10.1371/journal.pntd.0011071.r003
DOI:
10.1371/journal.pntd.0011071.r004
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2023
detail.hit.zdb_id:
2429704-5
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