Abstract
.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.
Highlights
AND OVERVIEW OF SCORE PORTFOLIO IN ELIMINATIONThe Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was started in late 2008 with a grant from the Bill & Melinda Gates Foundation (BMGF).[1]
We explored the time taken for shehias on Pemba and on Unguja to reach a zero level of S. haematobium prevalence among 9- to 12-year-old children
Research and program evaluations, such as those conducted by SCORE, are critical in defining how best to move toward elimination in places that have achieved very low levels of prevalence and intensity
Summary
The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was started in late 2008 with a grant from the Bill & Melinda Gates Foundation (BMGF).[1] The SCORE portfolio contains several efforts designed to increase knowledge about how to move from morbidity control toward elimination of schistosomiasis. The grant included support to develop and test better tools for mapping of Schistosoma mansoni infections and for a test with high sensitivity and specificity that would allow for diagnosis of schistosomiasis in an individual with a high degree of confidence. These tools are needed to move toward interruption of schistosomiasis transmission (elimination). SCORE’s work on developing and evaluating mapping and diagnostic tools is described in other articles in this supplement.[2,3]
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