Financial costs of CDD screening activity, per person targeted and by case confirmed (total and by phase).

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A multi-center field study of two point-of-care tests for circulating <i>Wuchereria bancrofti</i> antigenemia in Africa

<div><p>Background</p><p>The Global Programme to Eliminate Lymphatic Filariasis uses point-of-care tests for circulating filarial antigenemia (CFA) to map endemic areas and for monitoring and evaluating the success of mass drug administration (MDA) programs. We compared the performance of the reference BinaxNOW Filariasis card test (ICT, introduced in 1997) with the Alere Filariasis Test Strip (FTS, introduced in 2013) in 5 endemic study sites in Africa.</p><p>Methodology</p><p>The tests were compared prior to MDA in two study sites (Congo and Côte d'Ivoire) and in three sites that had received MDA (DRC and 2 sites in Liberia). Data were analyzed with regard to % positivity, % agreement, and heterogeneity. Models evaluated potential effects of age, gender, and blood microfilaria (Mf) counts in individuals and effects of endemicity and history of MDA at the village level as potential factors linked to higher sensitivity of the FTS. Lastly, we assessed relationships between CFA scores and Mf in pre- and post-MDA settings.</p><p>Principal findings</p><p>Paired test results were available for 3,682 individuals. Antigenemia rates were 8% and 22% higher by FTS than by ICT in pre-MDA and in post-MDA sites, respectively. FTS/ICT ratios were higher in areas with low infection rates. The probability of having microfilaremia was much higher in persons with CFA scores >1 in untreated areas. However, this was not true in post-MDA settings.</p><p>Conclusions/Significance</p><p>This study has provided extensive new information on the performance of the FTS compared to ICT in Africa and it has confirmed the increased sensitivity of FTS reported in prior studies. Variability in FTS/ICT was related in part to endemicity level, history of MDA, and perhaps to the medications used for MDA. These results suggest that FTS should be superior to ICT for mapping, for transmission assessment surveys, and for post-MDA surveillance.</p></div

Relationship between the ICT prevalence rate and the FTS/ICT ratio.

<p>All the data were included in this figure: Liberia (Foya and Harper), Côte d'Ivoire (Soribadougou and Yadio), Congo, DRC, Sri Lanka, and Indonesia (see <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0005703#pntd.0005703.t001" target="_blank">Table 1</a> for details). Foya and Harper study areas comprised 9 and 15 villages, respectively. Black symbols (post-MDA IVM+ALB), blue symbols (post-MDA DEC+ALB), green symbol (post-MDA ALB alone), and pink symbols (pre-MDA).</p

Results of the models exploring individual factors associated with ICT-miss (ICT-negative results in persons with positive FTS results).

<p>Results of the models exploring individual factors associated with ICT-miss (ICT-negative results in persons with positive FTS results).</p

STROBE statement—checklist of items that should be included in reports of cross-sectional studies.

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Demographic and clinical characteristics of confirmed cases of lymphatic filariasis morbidity identified.

(DOCX)</p

Existing and strengthened approach to community-based screening for lymphatic filariasis morbidity (LFM) in Côte d’Ivoire.

Existing and strengthened approach to community-based screening for lymphatic filariasis morbidity (LFM) in Côte d’Ivoire.</p

Cohen's Kappa score estimate obtained from a random-effects model.

<p>LH: Liberia Harper District. LF: Liberia Foya District. CDI: Côte d'Ivoire. One village (Wetchoken, in the Harper district) from Liberia was not added in this analysis because all the ICT were negative. "RE model" represents the pooled Cohen's Kappa scores by group from the random-effects models.</p

Cross-tabulation of individual test scores obtained with the FTS and ICT.

<p>Cross-tabulation of individual test scores obtained with the FTS and ICT.</p

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