A Latent Markov Modelling Approach to the Evaluation of Circulating Cathodic Antigen Strips for Schistosomiasis Diagnosis Pre- and Post-Praziquantel Treatment in Uganda
Author(s)
Type
Journal Article
Abstract
Regular treatment with praziquantel (PZQ) is the strategy for human schistosomiasis control aiming to prevent morbidity in later life. With the recent resolution on schistosomiasis elimination by the 65th World Health Assembly, appropriate diagnostic tools to inform interventions are keys to their success. We present a discrete Markov chains modelling framework that deals with the longitudinal study design and the measurement error in the diagnostic methods under study. A longitudinal detailed dataset from Uganda, in which one or two doses of PZQ treatment were provided, was analyzed through Latent Markov Models (LMMs). The aim was to evaluate the diagnostic accuracy of Circulating Cathodic Antigen (CCA) and of double Kato-Katz (KK) faecal slides over three consecutive days for Schistosoma mansoni infection simultaneously by age group at baseline and at two follow-up times post treatment. Diagnostic test sensitivities and specificities and the true underlying infection prevalence over time as well as the probabilities of transitions between infected and uninfected states are provided. The estimated transition probability matrices provide parsimonious yet important insights into the re-infection and cure rates in the two age groups. We show that the CCA diagnostic performance remained constant after PZQ treatment and that this test was overall more sensitive but less specific than single-day double KK for the diagnosis of S. mansoni infection. The probability of clearing infection from baseline to 9 weeks was higher among those who received two PZQ doses compared to one PZQ dose for both age groups, with much higher re-infection rates among children compared to adolescents and adults. We recommend LMMs as a useful methodology for monitoring and evaluation and treatment decision research as well as CCA for mapping surveys of S. mansoni infection, although additional diagnostic tools should be incorporated in schistosomiasis elimination programs.
Date Issued
2013-12-19
Date Acceptance
2013-10-28
Citation
PLOS Computational Biology, 2013, 9 (12)
ISSN
1553-734X
Publisher
Public Library of Science
Journal / Book Title
PLOS Computational Biology
Volume
9
Issue
12
Copyright Statement
© 2013 Koukounari et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Sponsor
Medical Research Council (MRC)
Medical Research Council (MRC)
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000329364800034&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Grant Number
G0902130
MR/K010174/1B
Subjects
Science & Technology
Life Sciences & Biomedicine
Biochemical Research Methods
Mathematical & Computational Biology
Biochemistry & Molecular Biology
BIOCHEMICAL RESEARCH METHODS
MATHEMATICAL & COMPUTATIONAL BIOLOGY
SOIL-TRANSMITTED HELMINTHS
FECAL EGG COUNTS
MANSONI INFECTION
KATO-KATZ
INTESTINAL SCHISTOSOMIASIS
URINARY SCHISTOSOMIASIS
ANODIC ANTIGEN
WESTERN KENYA
LAKE VICTORIA
COTE-DIVOIRE
Anthelmintics
Antigens, Protozoan
Humans
Markov Chains
Praziquantel
Schistosomiasis
Sensitivity and Specificity
Uganda
Bioinformatics
06 Biological Sciences
08 Information And Computing Sciences
01 Mathematical Sciences
Publication Status
Published
Article Number
ARTN e1003402