TABLE 3.

The 40 Statements and the Factor Array Scores of the 4 Factors

No Statement		Factors
No Statement		F1	F2	F3+	F3−	F4
	Context (Use Case)
1	Microscopy using a concentration technique is the recommended method to prove active schistosomiasis, despite its low sensitivity and need for expert users.	0	−1	−1	−2	−3
2	Diagnosis should include the identification of Schistosoma parasites in both humans and water sources that may be contaminated.	+2	0	+4	+2	0
3	Mass screening and diagnosis should be carried out alongside mass drug administration with praziquantel.	−2	−3	+4	−2	5
4	Schistosomiasis surveillance enables program managers to monitor the effectiveness of intervention strategies and identify which populations require continuing interventions.	−1	+5	+2	−1	+3
5	The availability of RDTs, which requires only minimal infrastructure, would improve diagnosis and surveillance simultaneously.	+3	−2^b	+3	+2	+5
6	Implementing an affordable and simple POC diagnostics solution will reduce the financial burden of equipment and personnel at each health facility.	0^b	−2	−2	4^b	−1
7	POC diagnostics that can detect and confirm cases immediately will reduce the risk of missed or misdiagnosed cases.	+2	0	−3^a	0	1
8	The quantification of egg excretion helps to assess the transmission potential of populations living in endemic areas.	−1	−2	1	−1	−2
9	Schistosomiasis control programs should target school-aged children only.	−6	−6	−1^b	−5	−6
10	Due to the low level of education and lack of training among community health workers, incorrect treatment is often prescribed.	−3^a	−1	0	0	3^b
11	Presenting data on the severity of schistosomiasis infection of specific locations will guide the development of strategies for effective case management and control elimination.	+1	+2	−6^b	+3	+1
12	Passive case detection, based on people’s self-reporting, has been considered a less expensive strategy for the control of schistosomiasis.	−3	−2	6^b	0	0
13	Prevalence and intensity of infection is often higher among children than among adults.	0	−1	−3	+1	0
	Infrastructure and location
14	Schistosomiasis diagnosis should be done closest to the community as it reduces the time to carry samples back to the laboratory.	0	+1	2	0	+4
15	Diagnostic and treatment campaigns should target school-age children, adolescents and those whose occupations involve contact with infectious water (e.g. fishing, farming, irrigation, and domestic tasks in water).	−2	+3	+1	+1	−1
16	Simple, rapid POC tests should be used in primary health care settings where patients often travel long distances to access health care facilities.	−1	−1	−2	+2	+2
17	Diagnostic devices should be deployed in primary health care centers, clinics, and health posts since they are the most lacking in equipment.	−4^a	+4	−1^a	+5	1^a
18	Testing of urine samples for schistosomiasis with school-based surveys should be done at the school location.	−1	+1	0	−2	−5
19	It is convenient to treat patients for schistosomiasis infection without a confirmed diagnosis due to the delay in receiving test results from referral hospitals.	−5	−5	−5	−4	−4
	Product requirement
20	Schistosomiasis elimination calls for developing novel diagnostic tools with higher sensitivity and specificity than microscopes.	+1	3^b	−4	−1	−3
21	Diagnostic device for schistosomiasis with minimal to no sample preparation is ideal.	−2	−3	−2	−3	−5^a
22	The diagnostic device should quantify eggs to provide an estimation of the number of people that have been exposed to schistosomiasis in a population.	5^a	−5^b	+1	−1^a	+2
23	Devices should be easy to use by medical personnel and health workers such as CHEWs, CHOs, laboratory scientists to detect and diagnose schistosomiasis-infected patients.	+1	+2	0	−5	−2
24	Patient samples should be processed in batches to get a faster turnaround time and increase the efficiency of sample processing during mass campaigns or sensitization meetings.	0	0	+1	−4^b	+3
25	Ideal diagnostic approaches should allow the concurrent detection of several pathogens in different biological samples such as urine, blood, and stool.	+3	0	+3	−3^a	+1
26	Diagnostic devices should be sensitive enough for detecting very light schistosomiasis infections.	+4	−3	+5	−1	−1
27	Diagnostic devices should have their own reliable power sources due to the unstable power connectivity in rural and distant communities.	+6	−1	−1	+6	+6
28	The best diagnostic devices should be easy to transport safely by car, motorbike, and bicycle to remote locations.	4^a	+1	−4	+2	−1
29	Diagnostic devices should be compact and portable so that they can be easily deployed in the community.	+2	0^a	+3	+3	−3^b
30	Diagnostic devices/tests should identify and map out areas with a large spread of schistosomiasis and be able to trace the source of the disease.	3a	0	0	0	−1
31	Devices should be locally repaired and maintained by local technicians in case of breakdown.	0	+2	−5^b	+4	0
32	The device should be easy to clean and disinfect to prevent re-contamination.	+1	+1	0	+1	+2
	Rollout strategy
33	The cost per diagnostic test should be free (covered by the government).	−1	4a	0	+1	−2
34	Cost per diagnostic test should be less than 1,000 Naira (US$2).	−5^b	6^a	−3	+3^a	−2
35	Mass drug administration campaigns should be accompanied by mass diagnostic and disease awareness campaigns.	−2	+2	+2	1	0
36	Data from diagnostic devices should be accessible to stakeholders (local government, DSNO, MOH, researchers, and NGOs) to enhance planning.	+1	+5	+2	0	+2
37	New interventions should consider training the health care workers at the community level and the informal sector (PMVs and traditional medicine) to increase coverage to diagnostics.	−3	+1	−1	−6^b	0
38	Diagnostic tools for schistosomiasis should be deployed and used at the community level by PMVs and community mobilizers as they already serve as trusted stakeholders in the community.	−4	−4	1^b	−3	−4
39	The role of the village/community head is important in the acceptance of the new diagnostic device.	+5	−4^a	−2^a	+5	1^b
40	Patients with schistosomiasis should be tested before being treated.	+2	+3	+5	−2^b	+4

Abbreviations: CHEW, community health extension worker; CHO, community health officer; DSNO, disease surveillance notification officer; MOH, medical officer of health; NGO, nongovernmental organization; PMV, patent medicine vendor; POC, point-of-care; RDT, rapid diagnostic test.
↵a Distinguishing statement significant at P<.05.
↵b Distinguishing statement significant at P<.01.