SCORE Operational Research on Moving toward Interruption of Schistosomiasis Transmission

• Published in: The American journal of tropical medicine and hygiene Vol. 103; no. 1_Suppl; pp. 58 - 65
• Main Authors: Campbell, Carl H, Binder, Sue, King, Charles H, Knopp, Stefanie, Rollinson, David, Person, Bobbie, Webster, Bonnie, Allan, Fiona, Utzinger, Jürg, Ame, Shaali M, Ali, Said M, Kabole, Fatma, N'Goran, Eliézer K, Tediosi, Fabrizio, Salari, Paola, Ouattara, Mamadou, Diakité, Nana R, Hattendorf, Jan, S Andros, Tamara, Kittur, Nupur, Colley, Daniel G
• Format: Journal Article
• Language: English
• Published: United States Institute of Tropical Medicine 01.07.2020; The American Society of Tropical Medicine and Hygiene
• Subjects: Animals; Anthelmintics - therapeutic use; Child; Clinical trials; Cote d'Ivoire - epidemiology; Disease control; Disease Reservoirs - parasitology; Disease transmission; Disease Vectors; Drug administration; Egypt - epidemiology; Humans; Kenya - epidemiology; Mass Drug Administration; Medical research; Parasitic diseases; Praziquantel - therapeutic use; Prevalence; Sanitation; Schistosoma haematobium - drug effects; Schistosomiasis haematobia - drug therapy; Schistosomiasis haematobia - prevention & control; Schistosomiasis haematobia - transmission; Schools; Snails - parasitology; Tanzania - epidemiology; Water - parasitology; Kenya; Cote d'Ivoire; Egypt; Tanzania; Africa
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.19-0825

As part of its diverse portfolio, the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) included two cluster-randomized trials evaluating interventions that could potentially lead to interruption of schistosomiasis transmission (elimination) in areas of Africa with low prevalence and intensity of infection. These studies, conducted in Zanzibar and Côte d'Ivoire, demonstrated that multiyear mass drug administration (MDA) with praziquantel failed to interrupt the transmission of urogenital schistosomiasis, even when provided biannually and/or supplemented by small-scale implementation of additional interventions. Other SCORE activities related to elimination included a feasibility and acceptability assessment of test-treat-track-test-treat (T5) strategies and mathematical modeling. Future evaluations of interventions to eliminate schistosomiasis should recognize the difficulties inherent in conducting randomized controlled trials on elimination and in measuring small changes where baseline prevalence is low. Highly sensitive and specific diagnostic tests for use in very low-prevalence areas for schistosomiasis are not routinely available, which complicates accurate measurement of infection rates and assessment of changes resulting from interventions in these settings. Although not encountered in these two studies, as prevalence and intensity decrease, political and community commitment to population-wide MDA may decrease. Because of this potential problem, SCORE developed and funded the T5 strategy implemented in Egypt, Kenya, and Tanzania. It is likely that focal MDA campaigns, along with more targeted approaches, including a T5 strategy and snail control, will need to be supplemented with the provision of clean water and sanitation and behavior change communications to achieve interruption of schistosome transmission.