Box 1.

Definition of case classification and treatment outcomes for visceral leishmaniasis (VL), in Abdurafi Health Center, Northwest Ethiopia. Adapted from Salih et al.²¹

	Definition
Primary VL	Patient presenting with VL symptoms with no history of previous VL and currently diagnosed with VL. Diagnosis relies on a positive serological test for VL (rK39 based rapid test and/or DAT direct agglutination test) and/or a positive parasitological test (microscopic detection of Leishmania parasites in splenic aspirate).
Relapse	Patient with a history of previous VL and who then presents with symptoms of VL and is parasitologically confirmed.
Initial cure	Patient who shows improvement of signs and symptoms at the end of treatment (fever resolution, hemoglobin increase, weight gain and spleen size regression), and a negative parasitological test of cure (TOC) if performed.
Initial failure	A positive TOC (parasitological failure) and/or persisting clinical signs/symptoms or failure to continue first-line treatment for safety reasons.
Slow responder	Partial clinical response but TOC positive (PVL and VL relapse); or no improvement in clinical symptoms and signs with a decrease in parasite load at the end of first-line VL treatment (defined at 4 weeks).
Test of cure (TOC)	Spleen, bone marrow, or Lymph node aspiration performed at the end of treatment to assess the parasitological response to therapy. A TOC is conducted for all VL relapse cases and HIV co-infected cases, and for HIV-negative primary VL cases if clinically indicated.
Defaulter	A patient who started VL treatment but interrupted treatment due to the patient leaving the hospital.
Lost to follow-up	Patient who was discharged with initial cure, but who did not return for 12 months follow-up visit.
Death	Death from any reason during treatment or up to 12 months of follow-up.
Definitive cure	Patient with initial cure showing no signs and symptoms of the disease during 12 months of follow-up. Definitive cure is ascertained at 12 months after treatment.