| Author | Coffeng, Luc E | |
| Author | Vlaminck, Johnny | |
| Author | Cools, Piet | |
| Author | Denwood, Matthew | |
| Author | Albonico, Marco | |
| Author | Ame, Shaali M | |
| Author | Ayana, Mio | |
| Author | Dana, Daniel | |
| Author | Cringoli, Giuseppe | |
| Author | Vlas, Sake J de | |
| Author | Fenwick, Alan | |
| Author | French, Michael | |
| Author | Kazienga, Adama | |
| Author | Keiser, Jennifer | |
| Author | Knopp, Stefanie | |
| Author | Leta, Gemechu | |
| Author | Matoso, Leonardo Ferreira | |
| Author | Maurelli, Maria P | |
| Author | Montresor, Antonio | |
| Author | Mirams, Greg | |
| Author | Mekonnen, Zeleke | |
| Author | Oliveira, Rodrigo Corrêa de | |
| Author | Pinto, Simone Aparecida | |
| Author | Rinaldi, Laura | |
| Author | Sayasone, Somphou | |
| Author | Steinmann, Peter | |
| Author | Thomas, Eurion | |
| Author | Vercruysse, Jozef | |
| Author | Levecke, Bruno | |
| Access date | 2023-06-26T14:35:26Z | |
| Available date | 2023-06-26T14:35:26Z | |
| Document date | 2023 | |
| Citation | COFFENG, Luc E et al. 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, v. 17, n. 5, p. e0011071-e0011071, 2023. doi.org/10.1371/journal.pntd.0011071. | en_US |
| ISSN | 1935-2735 | en_US |
| URI | https://www.arca.fiocruz.br/handle/icict/59172 | |
| Language | eng | en_US |
| Publisher | Public Library of Science | en_US |
| Rights | open access | en_US |
| Title | 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 | en_US |
| Type | Article | en_US |
| 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. | en_US |
| Affilliation | Department of Public Health. Erasmus MC. University Medical Center Rotterdam. Rotterdam, The Netherlands. | en_US |
| Affilliation | Department of Translational Physiology. Infectiology and Public Health. Ghent University. Merelbeke, Belgium. | en_US |
| Affilliation | Department of Diagnostic Sciences. Faculty of Medicine and Health Sciences. Ghent University. Ghent, Belgium. | en_US |
| Affilliation | Department of Veterinary and Animal Sciences. University of Copenhagen. Denmark. | en_US |
| Affilliation | National Health System. Turin, Italy. | en_US |
| Affilliation | Laboratory Division. Public Health Laboratory-Ivo de Carneri. Chake Chake, United Republic of Tanzania. | en_US |
| Affilliation | Department of Diagnostic Sciences. Faculty of Medicine and Health Sciences. Ghent University. Ghent, Belgium/Jimma University Institute of Health. Jimma University. Jimma, Ethiopia. | en_US |
| Affilliation | Department of Diagnostic Sciences. Faculty of Medicine and Health Sciences. Ghent University. Ghent, Belgium/Jimma University Institute of Health. Jimma University. Jimma, Ethiopia. | en_US |
| Affilliation | Department of Veterinary Medicine and Animal Production. University of Naples Federico II. Naples, Italy. | en_US |
| Affilliation | Department of Public Health. Erasmus MC. University Medical Center Rotterdam. Rotterdam, The Netherlands. | en_US |
| Affilliation | Schistosomiasis Control Initiative. Department of Infectious Disease Epidemiology. Imperial College London. London, United Kingdom | en_US |
| Affilliation | Schistosomiasis Control Initiative. Department of Infectious Disease Epidemiology. Imperial College London. London, United Kingdom/RTI International, Washington District of Columbia, United States of America. | en_US |
| Affilliation | Department of Translational Physiology. Infectiology and Public Health. Ghent University. Merelbeke, Belgium. | en_US |
| Affilliation | Swiss Tropical and Public Health Institute. Allschwil, Switzerland/University of Basel. Basel, Switzerland. | en_US |
| Affilliation | Swiss Tropical and Public Health Institute. Allschwil, Switzerland/University of Basel. Basel, Switzerland. | en_US |
| Affilliation | Ethiopian Public Health Institute. Addis Ababa, Ethiopia. | en_US |
| Affilliation | Laboratory of Molecular and Cellular Immunology. René Rachou Institute. Oswaldo Cruz Foundation. Belo Horizonte, MG, Brazil/Nursing school. Federal University of Minas Gerais. Belo Horizonte, MG, Brazil. | en_US |
| Affilliation | Department of Veterinary Medicine and Animal Production. University of Naples Federico II. Naples, Italy. | en_US |
| Affilliation | Department of Control of Neglected Tropical Diseases. World Health Organization. Geneva, Switzerland. | en_US |
| Affilliation | Techion Group Ltd, Dunedin, New Zealand. | en_US |
| Affilliation | Jimma University Institute of Health. Jimma University. Jimma, Ethiopia. | en_US |
| Affilliation | Oswaldo Cruz Foundation. Belo Horizonte, MG, Brazil. | en_US |
| Affilliation | Oswaldo Cruz Foundation. Belo Horizonte, MG, Brazil. | en_US |
| Affilliation | Department of Veterinary Medicine and Animal Production. University of Naples Federico II. Naples, Italy. | en_US |
| Affilliation | Lao Tropical and Public Health Institute. Ministry of Health. Vientiane, Lao People's Democratic Republic. | en_US |
| Affilliation | Swiss Tropical and Public Health Institute. Allschwil, Switzerland/University of Basel. Basel, Switzerland. | en_US |
| Affilliation | Techion Group Ltd. Aberystwyth, United Kingdom. | en_US |
| Affilliation | Department of Translational Physiology. Infectiology and Public Health. Ghent University. Merelbeke, Belgium. | en_US |
| Affilliation | Department of Translational Physiology. Infectiology and Public Health. Ghent University. Merelbeke, Belgium. | en_US |
