Summary of findings 2. Summary of findings table for tests to detect S. mansoni.

What is the diagnostic accuracy of circulating antigen tests for S. mansoni infection?
Patients/Population	People residing in areas endemic for S. mansoni infection (16 out of 90 studies)
Prior treatment with praziquantel before baseline study	Yes (1 study), No (5 studies), Unclear (10 studies)
Prior testing	None
Settings	Field settings (villages, schools, and military camp) in Africa and South America
Index tests	Circulating cathodic antigen test (CCA) Circulating anodic antigen test (CAA)a
Reference standard	Stool microscopy
Importance	These tests are being used as replacements for conventional microscopy in disease control programmes for schistosomiasis, as they are rapid, are easier to use and interpret, and may have comparable sensitivity to microscopy. As control programmes gain impetus and infection intensities decrease, higher sensitivities become a prerequisite for future diagnostics
Studies	Cross‐sectional studies
Quality concerns	Poor reporting of participant characteristics, index test and reference standard methods, and intensity of infection were common concerns. The risk of bias assessment for most included studies was largely unclear for the QUADAS domains Patient Selection, Index Tests, and Reference Tests
Test types	Number of evaluations	Summary estimates (95% CI)	In 1000 people tested
			Infected cases S. mansoni	Missed cases (FNs)	False‐positives (FPs)	All positives (TPs + FPs)
Circulating cathodic antigen test (CCA)
Urine POC test	15	Sens = 89% (86% to 92%); Spec = 55% (46% to 65%)	360	40	288	608

^a Studies were insufficient to provide summary estimates for CAA tests.

When measured against a higher‐quality reference standard, sensitivity of CCA POC for S. mansoni was comparable (88% vs 88%) but specificity was higher (66% vs 55%) than when measured against a lower‐quality reference standard.

At a positivity threshold ≥ 1, sensitivity of CCA POC for S. mansoni was lower (72% vs 87%) and specificity higher (85% vs 61%) than at a positivity threshold of trace‐positive.

Data were insufficient to estimate the sensitivity of CCA POC for S. mansoni in light‐intensity settings.

For the effects of risk of bias, sensitivity and specificity of CCA POC for S. mansoni were comparable when limited to studies with low risk of bias for the participant flow domain.

Abbreviations: TPs (true‐positives), FPs (false‐positives), FNs (false‐negatives).