01579nas a2200229   4500000000100000008004100001260001600042653001900058653001700077653001600094653002000110653002600130653003600156100001400192700001300206700001800219700001400237700001600251245007100267520099700338022001401335       2025                            d  bElsevier BV10aonchocerciasis10aTransmission10aElimination10aEarly diagnosis10aRapid diagnostic test10aPolymerase Chain Reaction (PCR)1 aLubbers C1 aAmaral L1 aColebunders R1 aBrattig N1 aHadermann A00aThe last mile in onchocerciasis elimination: diagnostic challenges3 a<p>Global elimination of onchocerciasis is progressing. However, challenges persist in achieving elimination across all endemic regions, particularly in sub-Saharan Africa, due to diagnostic limitations and operational complexity in coendemic, resource-constrained settings. This review synthesizes the historical and programmatic trajectory of onchocerciasis control, outlines the WHO elimination framework and evaluates diagnostic tools across programmatic phases. We examine clinical, molecular, serological, and entomological tools, highlighting the strengths and limitations while emphasizing the urgent need for field-deployable, high-sensitivity and non-invasive diagnostics to detect active&nbsp;<em>Onchocerca volvulus</em>&nbsp;infection. Novel tools show promise but require coordinated validation and integration into elimination programs. Success in the 'last mile' will depend on sensitive and specific diagnostics to detect low-level transmission and confirm elimination.</p>
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