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Abstract
Neglected Tropical Diseases (NTDs) marked out for disease elimination provide a lens through which to explore the changing status of diagnosis in global health. This paper reports on the findings of a scoping review, which set out to explore the main debates around diagnosis for the elimination of NTDs, including the multiple roles diagnostic technologies are being ascribed and the ideal characteristics of tests. It also attempts to summarise the state of diagnosis for three NTDs with elimination goals. The review places special emphasis on point-of-care testing in acknowledgement of the remote and underserved areas where NTDs proliferate. Early NTD campaigns were largely focused on attack phase planning, whereby a similar set of interventions could be transplanted anywhere. Now, with elimination goals in sight, strategies must be tailored to local settings if they are to attain and sustain success. Diagnostic data helps with local adaptation and is increasingly used for programmatic decision-making. The review finds that elimination goals reframe whom diagnosis is for and the myriad roles diagnostics can play. The exigencies of elimination also serve to highlight deficiencies in the current diagnostic arsenal and development pipeline for many NTDs. Moving forward, a guiding framework is needed to drive research and stimulate investment in diagnosis to support NTD goals.
Highlights
The current COVID-19 crisis has brought the importance of diagnosis into sharp relief, but even prior to this, the status of diagnosis in global health has been changing
This paper reports on the results of a formal scoping review to look into the state of diagnostics for the Neglected Tropical Diseases (NTDs) assigned disease elimination goals in the 2012 “NTD Roadmap” [3]
From an initial group of 17 diseases, 6 were immediately discounted for having goals related only to disease control, 2 were discounted for having eradication goals (Guinea-worm and yaws), and two were discounted for having no outstanding diagnostic need. This left seven NTDs, which became the focus of the review: Chagas disease, human African trypanosomiasis, lymphatic filariasis, onchocerciasis, schistosomiasis, trachoma, and visceral leishmaniasis
Summary
The current COVID-19 crisis has brought the importance of diagnosis into sharp relief, but even prior to this, the status of diagnosis in global health has been changing. Advisory Group for Neglected Tropical Diseases (NTDs), and in 2020 plans to launch a revised “NTD Roadmap”, for the period 2021–2030, assigning diagnosis a pivotal role [2]. This breaks with the peripheral position afforded diagnosis in the last “NTD Roadmap” [3], which served to formalise an ambitious disease elimination and eradication agenda for many of the named diseases but largely prioritised pharmaceutical solutions.
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