Abstract
.Herein, we summarize what we consider are major contributions resulting from the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) program, including its key findings and key messages from those findings. Briefly, SCORE’s key findings are as follows: i) biennial mass drug administration (MDA) with praziquantel can control schistosomiasis to moderate levels of prevalence; ii) MDA alone will not achieve elimination; iii) to attain and sustain control throughout endemic areas, persistent hotspots need to be identified following a minimal number of years of annual MDA and controlled through adaptive strategies; iv) annual MDA is more effective than biennial MDA in high-prevalence areas; v) the current World Health Organization thresholds for decision-making based on the prevalence of heavy infections should be redefined; and vi) point-of-care circulating cathodic antigen urine assays are useful for Schistosoma mansoni mapping in low-to-moderate prevalence areas. The data and specimens collected and curated through SCORE efforts will continue to be critical resource for future research. Besides providing useful information for program managers and revision of guidelines for schistosomiasis control and elimination, SCORE research and outcomes have identified additional questions that need to be answered as the schistosomiasis community continues to implement effective, evidence-based programs. An overarching contribution of SCORE has been increased cohesiveness within the schistosomiasis field-oriented community, thereby fostering new and productive collaborations. Based on SCORE’s findings and experiences, we propose new approaches, thresholds, targets, and goals for control and elimination of schistosomiasis, and recommend research and evaluation activities to achieve these targets and goals.
Highlights
As discussed in an earlier article in this supplement,[3] when Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was conceived in 2008, results from the Schistosomiasis Control Initiative (SCI; see www.schisto.org), originally funded by the BMGF, demonstrated that the stated goal of morbidity control of schistosomiasis using MDA with PZQ could be achieved at a national scale by MoH programs.[6]
The strategies of those programs for schistosomiasis were based on the WHO guidelines, which focused on reducing severe morbidity—not the subtle morbidities that were much more prevalent in endemic countries9—and largely copied mass campaigns to control and eliminate lymphatic filariasis through preventive chemotherapy administered through MDA annually for at least
The SCORE findings that we consider to be currently most pertinent to new guideline development are as follows: i) the use of the point-of-care circulating cathodic antigen (POC-CCA) urine assay for detecting S. mansoni infection and its relationship with the Kato–Katz technique based on stool samples; ii) that persistent hotspots (PHSs) do not respond to current recommendations for frequency and delivery platforms for MDA, are more common than previously thought, and can often be detected after two annual MDAs; and iii) the inappropriateness of current heavy infection intensity thresholds as cutoffs to define control of morbidity or elimination as a public health problem (EPHP)
Summary
The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE; see: https://score.uga.edu/) was funded by a major grant from the Bill & Melinda Gates Foundation (BMGF) to help answer the question: “What evidence will help neglected tropical disease (NTD) program managers to do their jobs better?” and to provide some of this evidence.[1,2,3] SCORE’s three objectives were focused on i) how best to do mass drug administration (MDA) with praziquantel (PZQ) and complementary interventions for gaining and sustaining control and elimination of schistosomiasis; ii) the development and evaluation of mapping, monitoring, surveillance, and diagnostic tools; and iii) synthesis and dissemination of the key SCORE findings to the World Health Organization (WHO) and governments of schistosomiasisendemic countries through the Ministry of Health (MoH) NTD program managers.
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