Table 2.

Operational research, evaluation, and tool needs, based on programmatic goals

Programmatic goal	Programmatic research and evaluation needs	Other research and assay needs
Gaining control*	Improved approaches to mapping, taking focal nature of schistosomiasis into account	Sensitive, specific field assays for low-to-moderate levels of S. haematobium infection
	Develop methods for early identification of persistent hotspots (PHSs) and responder villages (either before mapping or after a limited number—often as few as two—annual MDAs) and adaptive strategies
	Improve efficiency and effectiveness of mass drug administration by defining the following:
	Age-groups that need treatment, which may vary by PHSs versus responder villages and other factors
	How to achieve high coverage
	How to reach persistently noncompliant and persistently unreached individuals
Morbidity control†	All of the items under “gaining control”	S. haematobium assay, as described under “gaining control”
	Assess the utility of making schistosomiasis testing with dipsticks and/or point-of-care circulating cathodic antigen assay and praziquantel available in health centers	Develop proxies for measuring attributable fraction of morbidity due to schistosomiasis in a field-applicable manner
		Determine the potential morbidity from hybrid schistosomes
Elimination as a public health problem‡	Assess test, treat, track, test, and treat strategies (5T), for example, testing in schools to determine if prevalence is low and, if so, providing follow-up assessment of positive cases for family members or others who potentially share transmission sources instead of MDA (which would treat many uninfected)	Develop and evaluate highly sensitive and specific point-of-care assays for S. haematobium and S. mansoni when prevalence is 5% or less
	Assess contributions of interventions other than MDA, such as snail control, sanitation and clean water provision, and behavioral change interventions to achieve and/or maintain this level	Based either on (i) the proxies developed to actually measure morbidity or (ii) an arbitrary level of prevalence considered to eliminate schistosomiasis as a public health problem‡ and decide on a clear and measurable definition of elimination as a public health problem
	For snail control, this includes evaluating such questions as the optimal timing and frequency of mollusciding and ways of delivering molluscicides (e.g., spraying versus drip-feed versus slow release compounds) and the potential for community engagement in environmental interventions like clearing vegetation	Determine if hybrids pose a threat for continued transmission
	For behavior change, this includes using interventions developed using human-centered design and other community-engaged approaches	Determine the monitoring sampling schemes to be used for surveillance of humans and snails and the frequency that they will be used
Interruption of transmission§	Develop and evaluate a transmission assessment survey for schistosomiasis	Test surveillance-response approaches and their integration into local health systems
		Develop and evaluate diagnostic assays for surveillance and confirmation of human and snail infections once elimination is achieved and detectable prevalence of both is zero
	Implement protocols for surveillance response with appropriate diagnostic assays and response interventions to ensure elimination is maintained	Determine if animal reservoirs are a major contributor to transmission to humans

MDA = mass drug administration; POC-CCAs = point-of-care circulating cathodic antigen assays.

^*Arbitrarily defined as achieving and maintaining prevalence levels at or less than 25% by Kato–Katz/urine filtration or 50% by POC-CCA.

^†Arbitrarily defined as achieving and maintaining prevalence levels at or less than 15% by Kato–Katz/urine filtration or 30% by POC-CCA.

^‡Arbitrarily defined as achieving and maintaining prevalence levels at or less than 2% by Kato–Katz/urine filtration or 10% by POC-CCA.

^§Defined as zero transmission based on highly sensitive and specific survey diagnostics and/or zero anti-schistosome antibodies in 6- to 10-year-old children for three consecutive years, that is, passing a defined transmission assessment survey for 3 years.