The role of diagnostic technologies to measure progress toward WHO 2030 targets for soil-transmitted helminth control programs

Infections with soil-transmitted helminths (STHs) occurs throughout the developing world and are caused by 5 main species commonly known as roundworms (Ascaris lumbricoides), whipworms (Trichuris trichiura), hookworms (Ancylostoma duodenale and Necator americanus), and threadworm (Strongyloides). Recently, the World Health Organization (WHO) published its 2030 roadmap for STH preventive chemotherapy (PC) control programs [1]. In this roadmap, a total of 6 ambitious targets were identified, each with their corresponding milestones. The first 2 targets are to achieve and maintain elimination of STH-attributable (excluding Strongyloides) morbidity in pre-school age children (pre-SAC) and school-age children (SAC) by 2030 (Target #1) and to reduce the number of tablets needed in PC (Target #2). Target #3 aims increase domestic financial to support PC, whereas Targets #4 and #5 are aiming to establish an efficient control program specific for woman of reproductive age and strongyloidiasis in SAC, respectively. Finally, Target #6 aims to achieve universal access to basic sanitation and hygiene in STH-endemic areas. In the present viewpoint, we will reflect on the diagnostic technologies to measure progress toward Target #1 and Target #2 only. There, cost-effective diagnostics are a prerequisite to measure progress toward the set milestones. For Target #1, the milestone is the number of countries that have successfully reduced the prevalence of moderate and heavy intensity (M&HI) infections in children to less than 2% (2023: 70 countries; 2025: 90 countries; and 2030: 98 countries), whereas for Target #2, the milestone is the percentage reduction in number of anthelmintic tablets needed to deworm pre-SAC and SAC (2023: 20%; 2025: 30%; and 2030: 50%). For the latter target, a performant data reporting system feeds a decision tree to scale down the frequency of PC programs (and hence the number of anthelmintic tablets) based on prevalence of any STH infections. For the other targets, milestone indicators are in one way or another a coverage metric (Targets #4 to #6).