Modelling livestock test-and-treat: A novel One Health strategy to control schistosomiasis and mitigate drug resistance

Schistosomiasis, a neglected tropical disease, is widespread chronic helminthiasis reported in 78 countries, predominantly those within sub-Saharan Africa, as well Latin America, Asia, and most recently, even Europe. Species of the causative blood fluke infect not only humans but also animals, hybrids between previously assumed human-specific animal-specific schistosomes are being increasingly reported. Existing control programs across Africa focus on rely heavily mass drug administration praziquantel, sole available against schistosomiasis. Praziquantel safe highly efficacious could become ineffective if resistance emerges. To reach revised World Health Organization goal elimination schistosomiasis public health problem, interruption transmission selected regions, by 2030, new consideration role animal reservoirs human general, whether to treat livestock with praziquantel particular, has been raised. However, whilst there no dedicated targeting animals outside emerging reports use misuse Africa. Therefore, effectively help mitigate potential evolution resistance, structured strategies required. Here, using modelling approach, we evaluate effectiveness theoretical test-and-treat (TnT) strategy bovine currently point-of-care diagnostic test (developed for use) detect circulating cathodic antigen (POC-CCA). We show that implementing TnT at herd-level from 2022 2030 be effective suppressing infection cattle even, lower prevalence settings, reaching nominal ‘elimination’ targets. highlight importance enhancing specificity POC-CCA avoid unnecessary treatments discuss outstanding challenges associated part holistic One approach tackling