CHICAS, Lancaster Medical School, Lancaster University, Lancaster, LA1 3YF, UK.
Task Force for Global Health, 325 Swanton Way, Decatur, 30030, GA, USA.
Philos Trans R Soc Lond B Biol Sci. 2023 Oct 9;378(1887):20220276. doi: 10.1098/rstb.2022.0276. Epub 2023 Aug 21.
Current WHO guidelines set prevalence thresholds below which a neglected tropical disease can be considered to have been eliminated as a public health problem, and specify how surveys to assess whether elimination has been achieved should be designed and analysed, based on classical survey sampling methods. In this paper, we describe an alternative approach based on geospatial statistical modelling. We first show the gains in efficiency that can be obtained by exploiting any spatial correlation in the underlying prevalence. We then suggest that the current guidelines' implicit use of a significance testing argument is not appropriate; instead, we argue for a predictive inferential framework, leading to design criteria based on controlling the rates at which areas whose true prevalence lies above and below the elimination threshold are incorrectly classified. We describe how this approach naturally accommodates context-specific information in the form of georeferenced covariates that have been shown to be predictive of disease prevalence. Finally, we give a progress report of an ongoing collaboration with the Guyana Ministry of Health Neglected Tropical Disease programme on the design of an IDA (ivermectin, diethylcarbamazine and albendazole) Impact Survey of lymphatic filariasis to be conducted in Guyana in early 2023. This article is part of the theme issue 'Challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs'.
当前的世界卫生组织指南设定了流行阈值，低于该阈值，可认为某种被忽视的热带病已不再构成公共卫生问题，还规定了如何根据经典的调查抽样方法来设计和分析评估是否已消除的调查。在本文中，我们描述了一种基于地理空间统计建模的替代方法。我们首先展示了通过利用潜在流行率中的任何空间相关性可以获得的效率增益。然后，我们提出当前指南中隐含的显著性检验论点并不适用；相反，我们主张采用预测推理框架，从而制定基于控制真实流行率高于和低于消除阈值的区域被错误分类的速率的设计标准。我们描述了这种方法如何自然地适应以地理参考协变量的形式呈现的特定于上下文的信息，这些协变量已被证明可预测疾病流行率。最后，我们报告了与圭亚那卫生部被忽视热带病规划正在进行的合作的进展情况，该合作涉及在圭亚那于 2023 年初进行伊维菌素、乙胺嗪和阿苯达唑（IDA）淋巴丝虫病影响调查的设计。本文是主题为“防治被忽视热带病的挑战和机遇：距离伦敦宣言发布十年”的一部分。
