title: Evaluation of a Urine Pooling Strategy for the Rapid and Cost-Efficient Prevalence Classification of Schistosomiasis.
abstract: A key epidemiologic feature of schistosomiasis is its focal distribution, which has important implications for the spatial targeting of preventive chemotherapy programs. We evaluated the diagnostic accuracy of a urine pooling strategy using a point-of-care circulating cathodic antigen (POC-CCA) cassette test for detection of Schistosoma mansoni, and employed simulation modeling to test the classification accuracy and efficiency of this strategy in determining where preventive chemotherapy is needed in low-endemicity settings.
  
  
  
  We performed a cross-sectional study involving 114 children aged 6-15 years in six neighborhoods in Azaguié Ahoua, south Côte d'Ivoire to characterize the sensitivity and specificity of the POC-CCA cassette test with urine samples that were tested individually and in pools of 4, 8, and 12. We used a Bayesian latent class model to estimate test characteristics for individual POC-CCA and quadruplicate Kato-Katz thick smears on stool samples. We then developed a microsimulation model and used lot quality assurance sampling to test the performance, number of tests, and total cost per school for each pooled testing strategy to predict the binary need for school-based preventive chemotherapy using a 10% prevalence threshold for treatment.
  
  
  
  The sensitivity of the urine pooling strategy for S. mansoni diagnosis using pool sizes of 4, 8, and 12 was 85.9%, 79.5%, and 65.4%, respectively, when POC-CCA trace results were considered positive, and 61.5%, 47.4%, and 30.8% when POC-CCA trace results were considered negative. The modeled specificity ranged from 94.0-97.7% for the urine pooling strategies (when POC-CCA trace results were considered negative). The urine pooling strategy, regardless of the pool size, gave comparable and often superior classification performance to stool microscopy for the same number of tests. The urine pooling strategy with a pool size of 4 reduced the number of tests and total cost compared to classical stool microscopy.
  
  
  
  This study introduces a method for rapid and efficient S. mansoni prevalence estimation through examining pooled urine samples with POC-CCA as an alternative to widely used stool microscopy.
authors: Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, United States of America.
authors: Nathan C
authors: 0000-0002-5407-2005
authors: NC
authors: Lo
authors: Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire.|Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.|Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors: Jean T
authors: JT
authors: Coulibaly
authors: Division of General Medical Disciplines, Stanford University, Stanford, California, United States of America.|Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California, United States of America.
authors: Eran
authors: E
authors: Bendavid
authors: Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire.|Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.
authors: Eliézer K
authors: EK
authors: N'Goran
authors: Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors: Jürg
authors: J
authors: Utzinger
authors: Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors: Jennifer
authors: J
authors: Keiser
authors: Department of Medicine, University of Toronto, Toronto, Canada.|Divisions of Internal Medicine and Infectious Diseases, Toronto General Hospital, University Health Network, Toronto, Canada.
authors: Isaac I
authors: II
authors: Bogoch
authors: Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, United States of America.
authors: Jason R
authors: JR
authors: Andrews
mesh_terms: D000293:Adolescent; D000818:Animals; D000947:Antigens, Helminth / Q000652:urine*; D001499:Bayes Theorem; D018890:Chemoprevention / Q000295:instrumentation / Q000379:methods; D002648:Child; D007560:Cote d'Ivoire / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D055810:Lot Quality Assurance Sampling; D008297:Male; D019095:Point-of-Care Systems; D015995:Prevalence; D011933:Reagent Kits, Diagnostic / Q000191:economics; D012547:Schistosoma / Q000276:immunology / Q000302:isolation & purification*; D012552:Schistosomiasis / Q000145:classification / Q000453:epidemiology* / Q000469:parasitology; D012574:Schools / Q000191:economics / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D014556:Urine / Q000469:parasitology*
chemical_list: D000947:Antigens, Helminth; D011933:Reagent Kits, Diagnostic