Translating preventive chemotherapy prevalence thresholds for Schistosoma mansoni from the Kato-Katz technique into the point-of-care circulating cathodic antigen diagnostic test

Author summary:

The World Health Organization (WHO) has defined goals for schistosomiasis morbidity control to be reached by 2025 that are based on preventive chemotherapy. Intervention thresholds for Schistosoma mansoni are currently defined for prevalence measured by stool microscopy using the Kato-Katz technique. However, the Kato-Katz technique shows low sensitivity, particularly for the detection of light-intensity infections. Replacing it with the semi-quantitative point-of-care circulating cathodic antigen (POC-CCA) urine cassette test requires translation of the thresholds and precise characterization of the diagnostic sensitivity and specificity. In this study, we applied a novel egg-count model to a suite of data obtained from different settings in Africa and the Americas with diverse endemicity levels. We used a simulation study to infer on the relation between Kato-Katz and POC-CCA prevalence. Based on our study, we were able to provide recommendations for POC-CCA thresholds taking into account semi-quantitative results of the test. We found that a S. mansoni prevalence of 10% based on duplicate slide Kato-Katz thick smear is equivalent to 15–40% POC-CCA prevalence when trace results are considered positive and to 10–20% POC-CCA prevalence when trace results are considered negative. Our results have important bearings for mapping, control, surveillance, and verification of elimination of intestinal schistosomiasis.

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