Contributions of the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) to Schistosomiasis Control and Elimination: Key Findings and Messages for Future Goals, Thresholds, and Operational Research

Abstract

Herein, we summarize what we consider are major contributions resulting from the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) program, including its key findings and key messages from those findings. Briefly, SCORE's key findings are as follows: i) biennial mass drug administration (MDA) with praziquantel can control schistosomiasis to moderate levels of prevalence; ii) MDA alone will not achieve elimination; iii) to attain and sustain control throughout endemic areas, persistent hotspots need to be identified following a minimal number of years of annual MDA and controlled through adaptive strategies; iv) annual MDA is more effective than biennial MDA in high-prevalence areas; v) the current World Health Organization thresholds for decision-making based on the prevalence of heavy infections should be redefined; and vi) point-of-care circulating cathodic antigen urine assays are useful for Schistosoma mansoni mapping in low-to-moderate prevalence areas. The data and specimens collected and curated through SCORE efforts will continue to be critical resource for future research. Besides providing useful information for program managers and revision of guidelines for schistosomiasis control and elimination, SCORE research and outcomes have identified additional questions that need to be answered as the schistosomiasis community continues to implement effective, evidence-based programs. An overarching contribution of SCORE has been increased cohesiveness within the schistosomiasis field-oriented community, thereby fostering new and productive collaborations. Based on SCORE's findings and experiences, we propose new approaches, thresholds, targets, and goals for control and elimination of schistosomiasis, and recommend research and evaluation activities to achieve these targets and goals.

Circulating Anodic Antigen (CAA): A Highly Sensitive Diagnostic Biomarker to Detect Active Schistosoma Infections—Improvement and Use during SCORE

“…Although it would be useful for diagnosing individual infection status in travelers and others from developed countries spending time in endemic areas, the primary need is for schistosomiasis control and elimination programs, especially as prevalence in many endemic areas decreases and elimination becomes a more realistic programmatic goal. 46 Whether through commercialization of the assay or public/ private efforts, further exploration of how to build global capacity to implement this critical tool is essential.…”

The Schistosomiasis Consortium for Operational Research and Evaluation 2008–2020: Approaches, Experiences, Lessons, and Recommendations

“…Because SCORE studies were designed to contribute to an evidence base for WHO guidelines, the involvement of the WHO headquarters' NTD leadership in planning SCORE studies and as an active ad hoc member of the SCORE Advisory Committee has been essential, and SCORE findings are now contributing to WHO guidelines related to the use of the POC-CCA urine test for detecting S. mansoni infection and MDA in the control and elimination of schistosomiasis. 9…”

SCORE Operational Research on Moving toward Interruption of Schistosomiasis Transmission

“…16 The SCORE studies provide lessons learned for future research, such as the difficulty conducting randomized control trials (RCTs) to assess strategies to interrupt transmission of schistosomiasis. 42 Because cost considerations are likely to be important as countries move toward elimination, we suggest future research studies collect data prospectively, using specially designed tools, and ensure that staff who are collecting the data have adequate training and oversight, as discussed in another article in this supplement. 20 The countries that have eliminated schistosomiasis have generally done so as socioeconomic conditions have dramatically improved, in concert with decades of public health interventions.…”