A diagnostics platform for the integrated mapping, monitoring, and surveillance of neglected tropical diseases

Abstract

Control and elimination strategies for trachoma, lymphatic filariasis, onchocerciasis, schistosomiasis, ascariasis, trichuriasis and hookworm infection have striking similarities, including the use of periodic mass drug administration (MDA). Because these diseases tend to be co-endemic in the poorest communities of the poorest countries, such that multiple NTDs are frequently found not just in the same populations but within the same individuals [1], it has been suggested that mapping, treatment, impact monitoring, and post-elimination surveillance could be coordinated to better utilise limited human and financial resources. Although many programmes now distribute multiple anthelmintics simultaneously, progress in integrating mapping [2], [3], [4], monitoring, and surveillance [5] activities has been slow [6]. Ideally, population sampling strategies, fieldwork protocols, and sample types (e.g., blood or urine) could all be harmonised between diseases to increase population compliance, simplify overall survey procedures, and decrease costs. For each of these diseases, current diagnostic tools are imperfect (Table S1A), especially for areas with low prevalence. A cost-effective strategy for improved tool development would incorporate integration of diagnostic strategies from the outset [7], [8]. To review available methods for population-based assessment of NTDs, develop target product profiles for tools to monitor infection burden, and consider how those tools would be used in the context of disease elimination programmes, the London School of Hygiene & Tropical Medicine (LSHTM), in collaboration with the World Health Organization, held a consultation at LSHTM from July 19–20, 2010. Participants included disease experts, laboratory and field scientists, authorities on diagnostics, control programme managers, mathematical modellers, and health economists. By bringing together, for the first time, individuals with such a broad spectrum of intersecting disease- and discipline-specific interests to consider issues surrounding integration of diagnostic systems, the consultation aimed to improve on the usual vertical approach to tropical diseases research, encouraging formulation of an innovative approach. This article summarises that consultation's outcomes, suggests target product profiles and a list of immediate research priorities, and drafts a road map for future efforts. We argue for development of a multiplex platform for NTD mapping, monitoring, and surveillance, and suggest changes to policy that might ensue if such a system were to become available.