Coffeng, L. E. and Vlaminck, J. and Cools, P. and Denwood, M. and Albonico, M. and Ame, S. M. and Ayana, M. and Dana, D. and Cringoli, G. and de Vlas, S. J. and Fenwick, A. and French, M. and Kazienga, A. and Keiser, J. and Knopp, S. and Leta, G. and Matoso, L. F. and Maurelli, M. P. and Montresor, A. and Mirams, G. and Mekonnen, Z. and Corrêa-Oliveira, R. and Pinto, S. A. and Rinaldi, L. and Sayasone, S. and Steinmann, P. and Thomas, E. and Vercruysse, J. and Levecke, B..
(2023)
A general framework to support cost-efficient fecal egg count methods and study design choices for large-scale STH deworming programs-monitoring of therapeutic drug efficacy as a case study.
PLoS Negl Trop Dis, 17 (5).
e0011071.
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Abstract
BACKGROUND: 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 FECPAKG2). 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 FECPAKG2 required both the most laboratory time and was the most expensive. Counting of eggs accounted for 23% (FECPAKG2) 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.
Faculties and Departments: | 09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) 09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Medical Parasitology and Infection Biology (MPI) > Helminth Drug Development (Keiser) 09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Eco System Health Sciences > Ecosystem Services, Climate & Health (Cissé) 09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Swiss Centre for International Health (SCIH) > Diseases and Programmes (Steinmann) |
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UniBasel Contributors: | Keiser, Jennifer and Knopp, Stefanie and Steinmann, Peter |
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Item Type: | Article, refereed |
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Article Subtype: | Research Article |
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ISSN: | 1935-2735 (Electronic)1935-2727 (Linking) |
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Note: | Publication type according to Uni Basel Research Database: Journal article |
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Language: | English |
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Last Modified: | 07 Jun 2023 06:30 |
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Deposited On: | 07 Jun 2023 06:30 |
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