01953nas a2200169   4500000000100000008004100001260003700042653005700079653002400136100001200160700001300172245011100185300001300296490000700309520145300316022001401769       2020                            d  bPublic Library of Science (PLoS)10aPublic Health, Environmental and Occupational Health10aInfectious Diseases1 aGass KM1 aPappas G00aTime for a diagnostic sea-change: Rethinking neglected tropical disease diagnostics to achieve elimination  ae00089330 v143 aNever before has the importance of good diagnostic tests received such global attention. With the Coronavirus Disease 2019 (COVID-19) pandemic, sensitivity and specificity have become household terms. For neglected tropical diseases (NTDs), the need for good diagnostics is nothing new, but has grown increasingly acute in recent years. While today’s diagnostic tools have been sufficient for endemicity mapping and monitoring the progress of mass drug administration (MDA), they are largely insufficient for making stop treatment and surveillance decisions.

A diagnostic sea change is required to develop new tests capable of taking NTD programs to the finish line of elimination. This starts with recognition that the testing needs for NTDs are unique. Unlike malaria, tuberculosis, or HIV, the preventative chemotherapy (PC)–treated NTDs are largely asymptomatic, and consequently, tests are rarely used to make individual diagnoses. Instead, NTD programs rely on tests to make good public health decisions. These decisions are made by applying diagnostic tests in conjunction with World Health Organization (WHO)–approved monitoring and evaluation (M&E) tools, which typically take the form of population-based surveys. Accurate program decisions can only be made with tests that are fit for purpose. Deploying such tests will require the NTD community to make 4 important changes in the way diagnostic tests are developed and applied.  a1935-2735