Performance of Tests for Schistosoma Haematobium Diagnosis (SchistoBreak-D)

Schistosoma Haematobium Diagnostic Test Performance in the Elimination Setting Pemba, Tanzania

Urogenital schistosomiasis caused by infection with the blood fluke Schistosoma haematobium is a debilitating disease. The World Health Organization (WHO) has set the goal to eliminate schistosomiasis as a public health problem globally by 2030 and to interrupt transmission in selected areas. Many years of control interventions and mass drug administration have reduced substantially the prevalence and infection intensities in several areas. In areas with an infection prevalence <10%, the WHO suggests to continue population preventive chemotherapy with praziquantel at the same or reduced frequency, or to use a clinical approach of test-and-treat. In areas that have achieved interruption of transmission, elimination needs to be validated and post-elimination surveillance be implemented.

For determination of infection prevalence thresholds, for test-and-treat, for validation of elimination and for pre- and post-elimination surveillance, reliable diagnostic tools are needed.

In a single-centre study conducted in Pemba, United Republic of Tanzania, the investigators aim to assess the accuracy and performance of standard and new diagnostic tests for S. haematobium diagnosis for use in elimination settings.

The primary objective of the study is to assess the sensitivity and specificity of all investigated diagnostic tests, using the S. haematobium egg count results of five urine filtrations conducted on five urine samples collected over five consecutive days as reference test.

Secondary objectives are:

• To assess the sensitivity and specificity of all investigated diagnostic tests, using latent class analyses.
• To assess the sensitivity and specificity of all investigated diagnostic tests, in relation to S. haematobium infection intensity, calculated as mean egg count derived from the egg counts in five urine samples collected over 5 consecutive days.
• To assess the sensitivity and specificity of all investigated diagnostic tests, in relation to S. haematobium infection intensity, calculated from the egg counts of the urine sample that was analysed with the respective test and urine filtration.
• To assess the sensitivity and specificity of all investigated diagnostic tests, using the results of the up-converting reporter particle-lateral flow circulating anodic antigen assay (UCP-LF CAA) as reference test.
• To assess the sensitivity and specificity of all investigated molecular diagnostic tests, using the results of the qPCR as reference test.
• To assess the cost and time needed for the implementation of single or multiple-throughput tests.

Our study will evaluate the accuracy and performance of diagnostic tests, in a formerly highly endemic setting that is now approaching elimination (Pemba), and will hence provide important information about which tests can be recommended for threshold determination, and test-and-treat and surveillance.

Study Overview

• Status: Completed
• Conditions: Schistosoma Haematobium
• Intervention / Treatment: Diagnostic test: S. haematobium egg detection by single urine filtration; Diagnostic test: Haematuria assessment using reagent strips; Diagnostic test: S. haematobium egg detection by quintuple urine filtration; Diagnostic test: S. haematobium egg detection by artificial intelligence (AI) microscopy; Diagnostic test: S. haematobium antigen detection by up-converting reporter particle-lateral flow circulating anodic antigen assay (UCP-LF CAA); Diagnostic test: S. haematobium DNA detection by recombinase polymerase amplification assay (RPA); Diagnostic test: S. haematobium DNA detection by qPCR

• Study Type: Observational
• Enrollment (Actual): 801

Contacts and Locations

Study Locations

• Tanzania
  • Pemba Island
    • Chake Chake, Pemba Island, Tanzania
      • Public Health Laboratory - Ivo de Carneri (PHL-IdC)

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Probability Sample

Study Population

Children from Pemba Island, United Republic of Tanzania, that attend one among the two pre-selected study primary schools in grade 3, 4, 5 or 6.

Description

Inclusion Criteria:

Subjects fulfilling all of the following inclusion criteria are eligible for the initial screening:

• Attendance of grade 3, 4, 5, or 6 in study school
• Randomized to participate in initial screening
• Written informed consent signed by the parents
• Written assent signed by the participant if aged12-17 years old

Subjects fulfilling all of the following inclusion criteria are eligible for the diagnostic study:

• Attendance of grade 3, 4, 5, or 6 in study school
• Randomized to participate in initial screening
• Written informed consent signed by the parents
• Written assent signed by the participant if aged12-17 years old
• S. haematobium-positive urine filtration result in initial screening OR
• S. haematobium-negative urine filtration result in initial screening, but randomized for participation in diagnostic study

Exclusion Criteria:

The presence of any one of the following exclusion criteria will lead to the exclusion of the subject in the initial screening:

• Not attending any study school
• Not attending grade 3, 4, 5 or 6
• Not randomized to participate in initial screening
• No written informed consent signed by the parents submitted
• No written assent signed by the participant if aged12-17 years old submitted
• S. haematobium-negative urine filtration result in initial screening, and not randomized for participation in diagnostic performance study
• Clinical significant sever disease

The presence of any one of the following exclusion criteria will lead to the exclusion of the subject in the diagnostic study:

• Not attending any study school
• Not attending grade 3, 4, 5 or 6
• Not randomized to participate in initial screening
• No written informed consent signed by the parents submitted
• No written assent signed by the participant if aged12-17 years old submitted
• S. haematobium-negative urine filtration result in initial screening, and not randomized for participation in diagnostic performance study
• Clinical significant sever disease

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Participants of initial screening; Schoolchildren that attend classes in grades 3-6 in each of the two study schools will be invited to submit one urine sample that will be tested with a single urine filtration (Day 1).	Diagnostic test: S. haematobium egg detection by single urine filtration; The urine samples of children participating in the initial screening will be tested with a single urine filtration by human microscopy.; Diagnostic test: Haematuria assessment using reagent strips; The urine samples collected from children participating in the initial screening and in the diagnostic study, respectively, will be tested with reagent strips.
Participants of diagnostic study; All schoolchildren that are tested S. haematobium-positive children in the initial screening plus a sex-adjusted random selection of initially negative-screened children will be included in the diagnostic study. These children will be invited to submit five urine samples in total, over five days (Day 1-5). All samples (Day 1-5) will be tested with a single urine filtration. Samples collected on Day 5 will be tested with all investigated diagnostic tests.	Diagnostic test: S. haematobium egg detection by single urine filtration; The urine samples of children participating in the initial screening will be tested with a single urine filtration by human microscopy.; Diagnostic test: Haematuria assessment using reagent strips; The urine samples collected from children participating in the initial screening and in the diagnostic study, respectively, will be tested with reagent strips.; Diagnostic test: S. haematobium egg detection by quintuple urine filtration; Five urine samples will be collected from children participating in the diagnostic study over five days. Each of the five urine samples collected per participant will be tested with a single urine filtration by human microscopy.; Diagnostic test: S. haematobium egg detection by artificial intelligence (AI) microscopy; The urine samples collected on Day 5 of the diagnostic study will be tested with artificial intelligence (AI) microscopy.; Diagnostic test: S. haematobium antigen detection by up-converting reporter particle-lateral flow circulating anodic antigen assay (UCP-LF CAA); The urine samples collected on Day 5 of the diagnostic study will be tested with the up-converting reporter particle-lateral flow circulating anodic antigen assay (UCP-LF CAA).; Diagnostic test: S. haematobium DNA detection by recombinase polymerase amplification assay (RPA); The urine samples collected on Day 5 of the diagnostic study will be tested with the recombinase polymerase amplification assay (RPA).; Diagnostic test: S. haematobium DNA detection by qPCR; The urine samples collected on Day 5 of the diagnostic study will be tested with qPCR

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Accuracy of tests for S. haematobium diagnosis when compared with a single urine filtration	The primary endpoint will be the sensitivity of the investigated diagnostic tests to detect S. haematobium related markers by the examination of a single sample. The primary outcome variable will be the number of S. haematobium infected individuals detected through each test.	From enrollment to the end of the study after 6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Sensitivity of each diagnostic test (human microscopy, AI microscopy, reagent strips, RPA, UCP-CAA, qPCR).	Sensitivity is defined as the proportion of positive test results out of all truly positive samples. Reference tests are human microscopy, UCP-CAA, qPCR or a combination thereof, performed with the same urine sample (human microscopy, UCP-CAA, qPCR) or quintuple urine samples (human microscopy).	From enrollment to the end of the study after 6 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Specificity of each diagnostic test (human microscopy, AI microscopy, reagent strips, RPA, UCP-CAA, qPCR).	Specificity is defined as the proportion of negative test results out of all truly negative samples. Reference tests are human microscopy, UCP-CAA, qPCR or a combination thereof, performed with the same urine sample (human microscopy, UCP-CAA, qPCR) or quintuple urine samples (human microscopy).	From enrollment to the end of the study after 6 weeks.
Correlation of infection markers.	Correlation of the amount of infection markers measured by each test (human microscopy: number of S. haematobium eggs, AI microscopy: number of S. haematobium eggs, reagent strips: microhaematuria grading, RPA: fluorescence level, UCP-CAA: amount of CAA antigen, qPCR: cycle-threshold values).	From enrollment to the end of the study after 6 weeks.
Costs of each diagnostic test (human microscopy, AI microscopy, reagent strips, RPA, UCP-CAA, qPCR).	Costs are defined as the financial costs incurred by each test for equipment, consumables, and staff time to perform the test.	6 month, from start of orders of equipment and material to end of laboratory work.
Time to conduct each diagnostic test (human microscopy, AI microscopy, reagent strips, RPA, UCP-CAA, qPCR).	Amount of time spent completing each test.	From enrollment to the end of the study after 6 weeks.

Collaborators and Investigators

• Sponsor: Stefanie Knopp
• Collaborators: Erasmus Medical Center; Leiden University Medical Center; Natural History Museum, United Kingdom; Public Health Laboratory Ivo de Carneri; Enaiblers AB
• Investigators: Principal Investigator: Stefanie Knopp, PhD, Swiss Tropical & Public Health Institute; Study Director: Said M Ali, MSc, Public Health Laboratory Ivo de Carneri

Study record dates

Study Major Dates

• Study Start (Actual): February 10, 2025
• Primary Completion (Actual): April 30, 2025
• Study Completion (Actual): April 30, 2025

Study Registration Dates

• First Submitted: January 8, 2025
• First Submitted That Met QC Criteria: January 29, 2025
• First Posted (Actual): February 5, 2025

Study Record Updates

• Last Update Posted (Estimated): September 19, 2025
• Last Update Submitted That Met QC Criteria: September 15, 2025
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Keywords: control; diagnosis; schistosomiasis; elimination
• Additional Relevant MeSH Terms: Vector Borne Diseases; Urogenital Diseases; Pathologic Processes; Male Urogenital Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Infections; Parasitic Diseases; Helminthiasis; Trematode Infections; Urinary Tract Infections; Pathological Conditions, Signs and Symptoms; Disease; Schistosomiasis; Schistosomiasis haematobia; Investigative Techniques; Diagnostic Techniques and Procedures; Diagnosis; Diagnostic Imaging; Microscopy
• Other Study ID Numbers: 1687; PR00P3_179753 (Other Grant/Funding Number: Swiss National Science Foundation)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: There are data transfer agreements (DTAs) in place between the Public Health Laboratory-Ivo de Carneri (PHL-IdC) in Pemba and the Swiss Tropical and Public Health Institute (Swiss TPH), Switzerland; Leiden University Medical Centre (LUMC), The Netherlands; Natural History Museum (NHM), London, UK; and Enaiblers, Sweden.; Anonymized data will be curated and stored for an unlimited period in the data repository "Infectious Diseases Data Observatory" (IDDO; https://www.iddo.org/) and/or Zenodo (https://zenodo.org/).; Data may be shared with other researchers upon request.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No