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Targets set in this roadmap have not been met, but <ns4:italic>T. solium<\/ns4:italic> has been included in the consultation process for the new 2030 goals proposed for priority NTDs. <ns4:italic>Taenia solium<\/ns4:italic> transmission dynamics models can contribute to this process. A recent review has compared existing <ns4:italic>T. solium<\/ns4:italic> transmission models, identifying their similarities and differences in structure, parameterization and modelled intervention approaches. While a formal model comparison to investigate the impact of interventions is yet to be conducted, the models agree on the importance of coverage for intervention effectiveness and on the fact that human- and pig-focused interventions can be optimally combined. One of these models, cystiSim, an individual-based, stochastic model has been used to assess field-applicable interventions, some currently under evaluation in on-going trials in Zambia. The EPICYST, population-based, deterministic model has highlighted, based on simulating a generic sub-Saharan Africa setting, the higher efficacy (measured as the percentage of human cysticercosis cases prevented) of biomedical interventions (human and pig treatment and pig vaccination) compared to improved husbandry, sanitation, and meat inspection. Important questions remain regarding which strategies and combinations thereof provide sustainable solutions for severely resource-constrained endemic settings. Defining realistic timeframes to achieve feasible targets, and establishing suitable measures of effectiveness for these targets that can be quantified with current monitoring and evaluation tools, are current major barriers to identifying validated strategies. <ns4:italic>Taenia solium<\/ns4:italic> transmission models can support setting achievable 2030 goals; however, the refinement of these models is first required. Incorporating socio-economic elements, improved understanding of underlying biological processes, and consideration of spatial dynamics are key knowledge gaps that need addressing to support model development.<\/ns4:p>","DOI":"10.12688\/gatesopenres.13068.2","type":"journal-article","created":{"date-parts":[[2019,12,13]],"date-time":"2019-12-13T10:00:06Z","timestamp":1576231206000},"page":"1546","update-policy":"https:\/\/doi.org\/10.12688\/gatesopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["The World Health Organization 2030 goals for Taenia solium: Insights and perspectives from transmission dynamics modelling"],"prefix":"10.12688","volume":"3","author":[{"name":"CystiTeam Group for Epidemiology and Modelling of Taenia solium Taeniasis\/Cysticercosis","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2019,12,13]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"e0003570","DOI":"10.1371\/journal.pntd.0003570","article-title":"Why latrines are not used: communities' perceptions and practices regarding latrines in a Taenia solium endemic rural area in Eastern Zambia.","volume":"9","author":"S Thys","year":"2015","journal-title":"PLoS Negl Trop Dis."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"1859-1922","DOI":"10.1016\/S0140-6736(18)32335-3","article-title":"Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.","volume":"392","year":"2018","journal-title":"Lancet."},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"e1001920","DOI":"10.1371\/journal.pmed.1001920","article-title":"World Health Organization Estimates of the Global and Regional Disease Burden of 11 Foodborne Parasitic Diseases, 2010: A Data Synthesis.","volume":"12","author":"P Torgerson","year":"2015","journal-title":"PLoS Med."},{"key":"ref-4","doi-asserted-by":"publisher","first-page":"e2865","DOI":"10.1371\/journal.pntd.0002865","article-title":"The global burden of disease study 2010: interpretation and implications for the neglected tropical diseases.","volume":"8","author":"P Hotez","year":"2014","journal-title":"PLoS Negl Trop Dis."},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"261-274","DOI":"10.1179\/2047773212Y.0000000047","article-title":"Neurocysticercosis in sub-Saharan Africa: a review of prevalence, clinical characteristics, diagnosis, and management.","volume":"106","author":"A Winkler","year":"2012","journal-title":"Pathog Glob Health."},{"key":"ref-6","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1186\/s13071-018-3153-5","article-title":"Epidemiology of taeniosis\/cysticercosis in Europe, a systematic review: eastern Europe.","volume":"11","author":"C Trevisan","year":"2018","journal-title":"Parasit Vectors."},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"141-154","DOI":"10.1016\/j.actatropica.2015.12.021","article-title":"The societal cost of Taenia solium cysticercosis in Tanzania.","volume":"165","author":"C Trevisan","year":"2017","journal-title":"Acta Trop."},{"key":"ref-8","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1186\/s12879-018-3030-z","article-title":"Assessment of the societal cost of Taenia solium in Ang\u00f3nia district, Mozambique.","volume":"18","author":"C Trevisan","year":"2018","journal-title":"BMC Infect Dis."},{"key":"ref-9","doi-asserted-by":"publisher","first-page":"63-67","DOI":"10.1016\/j.vetpar.2018.01.001","article-title":"Taenia solium from a community perspective: Preliminary costing data in the Katete and Sinda districts in Eastern Zambia.","volume":"251","author":"E Hobbs","year":"2018","journal-title":"Vet Parasitol."},{"key":"ref-10","first-page":"223-228","article-title":"The marketing of cysticercotic pigs in the Sierra of Peru. 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Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/gatesopenresearch.org\/articles\/3-1546\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/gatesopenresearch.org\/articles\/3-1546\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/gatesopenresearch.org\/articles\/3-1546\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,12,13]],"date-time":"2019-12-13T10:00:12Z","timestamp":1576231212000},"score":1,"resource":{"primary":{"URL":"https:\/\/gatesopenresearch.org\/articles\/3-1546\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12,13]]},"references-count":63,"URL":"https:\/\/doi.org\/10.12688\/gatesopenres.13068.2","relation":{},"ISSN":["2572-4754"],"issn-type":[{"value":"2572-4754","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12,13]]},"assertion":[{"value":"Indexed","URL":"https:\/\/gatesopenresearch.org\/articles\/3-1546\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/gatesopenres.14200.r27944, Ana Flisser Steinbruch, National Autonomous University of Mexico, Mexico City, Mexico, 01 Oct 2019, version 1, indexed","URL":"https:\/\/gatesopenresearch.org\/articles\/3-1546\/v1#referee-response-27944","order":0,"name":"referee-response-27944","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Maria-Gloria Basanez<\/b>; \n<i>Posted: 13 Dec 2019<\/i>; \n<b>Reviewer #1 <\/b>(Ana Flisser Steinbruch) \n<b>Reviewer\u2019s summary.<\/b> This paper is very interesting and well written. \n<b>Authors\u2019 response to summary. <\/b>We thank the reviewer for these comments. &nbsp; \n<b>Reviewer\u2019s comment 1.1. <\/b>Page 1, right column, please delete as marked: This further supports the argument for a One Health approach, including humans and non-human animals as well as the environment. \n<b>Authors\u2019 response 1.1. <\/b>We thank the Reviewer for this comment; however, we argue that this statement should be maintained in the manuscript, with the previous sentence supporting that combined interventions (aimed at both human and pig hosts) advocate for a cross-sector, One Health strategy, to control \n<i>T. solium<\/i>:  \n<i>\u201cA recent systematic review analysed the available evidence on the effectiveness of TS intervention options<sup>26<\/sup>, concluding that combined human- and pig-focussed interventions are the most promising strategies for achieving rapid declines in infection<sup>27<\/sup> and enhancing prospects for regional elimination<sup>27<\/sup>.\u201d<\/i> &nbsp; \n<b>Reviewer\u2019s comment 1.2. <\/b>The only mention to health education is exactly before 2) Spatial elements, as follows &quot;Health education will also be setting-dependent given varying husbandry and sanitation practices, and it would be highly valuable to test its impact with the transmission dynamics models as and when data become available on the impact of health education on TS transmission&quot;. To this regard, there are a few studies available in which health education was evaluated (Mexico and Tanzania) but no mention is given to these studies. \n<b>Authors\u2019 response 1.2. <\/b>We appreciate the reviewer\u2019s insight into this area of \n<i>T. solium<\/i> research, and her suggestion that other references may be used. We have, therefore, included the following text in the revised manuscript:  \n<i>\u201cIn a rural Mexican community, health education, developed with community-participation, showed reductions in pig foraging behaviour and access to infective material, accompanied by reductions in pig cysticercosis prevalence<sup>22<\/sup>. Improvement in knowledge areas associated with reducing risk factors through health education, directed at school-age children<sup>23<\/sup>, has highlighted the role of health education campaigns.\u201d<\/i>  With the additional references:  22. Sarti E, Flisser A, Schantz PM, Gleizer M, Loya M, Plancarte A, \n<i>et al<\/i>.: \n<b>Development and evaluation of a health education intervention against <i>Taenia solium<\/i> in a rural community in Mexico.<\/b> \n<i>Am J Trop Med Hyg.<\/i> 1997; 56(2): 127-132. 23. Mwidunda SA, Carabin H, Matuja WBM, Winkler AS, Ngowi HA. \n<b>A school based cluster randomised health education intervention trial for improving knowledge and attitudes related to <i>Taenia solium<\/i> cysticercosis and taeniasis in Mbulu District, Northern Tanzania<\/b>. \n<i>PLoS One. <\/i>2015; 10(2): e0118541.  \n<b>Reviewer\u2019s comment 1.3. <\/b>In spatial elements, there are three references regarding clustering of pig cysticercosis to human taeniasis, but the original reference is absent, could the authors please include it: Sarti-Gutierrez et al. (1988). Furthermore, in 1) Integration with other NTD programs, the authors state that there are no publications on the &quot;risks of serious adverse events associated with NCC cases [ASW, unpublished data]. I recommend the authors to read Flisser et al. (1993). \n<b>Authors\u2019 response 1.3. <\/b>We thank the reviewer for highlighting an original reference on the clustering issue which we have now included:  53. Sarti-Gutierrez EJ, Schantz PM, Lara-Aguilera R, Gomez Dandoy H, Flisser A. \n<b><i>Taenia solium<\/i> taeniasis and cysticercosis in a Mexican village.<\/b> \n<i>Trop Med Parasitol<\/i>. 1988; 39(3): 194-98.  We have also included the suggested reference regarding risks of serious adverse events associated with treatment of NCC cases:  16. Flisser A, Madrazo I, Plancarte A, Schantz P, Allan J, Craig P, Sarti E. \n<b>Neurological symptoms in occult neurocysticercosis after single taeniacidal dose of praziquantel<\/b>. \n<i>Lancet.<\/i> 1993; 342(8873): 748. &nbsp; \n<b>Reviewer\u2019s comment 1.4. <\/b>In Figure 4, more or less where red pork meat is seen, I would add another window of information regarding KAP (knowledge, attitudes and practices) needed to be able to control cysticercosis\/taeniasis. \n<b>Authors\u2019 response 1.4. <\/b>We thank the reviewer for this suggestion, and have added KAP (knowledge, attitudes and practices) to the existing \u201cPig to human transmission\u201d and \u201cEnvironment to pig transmission\u201d boxes. &nbsp; \n<b>Reviewer\u2019s comment 1.5. <\/b>I especially enjoyed Table 1. \n<b>Authors\u2019 response 1.5. <\/b>We thank the reviewer for this appreciative comment.","URL":"https:\/\/gatesopenresearch.org\/articles\/3-1546\/v2#referee-comment-3255","order":1,"name":"referee-comment-3255","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/gatesopenres.14200.r27943, Joaquin M. Prada, School of Veterinary Medicine, Faculty of Health and Medical Sciences, University Of Surrey, Guildford, UK, 15 Oct 2019, version 1, indexed","URL":"https:\/\/gatesopenresearch.org\/articles\/3-1546\/v1#referee-response-27943","order":2,"name":"referee-response-27943","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Maria-Gloria Basanez<\/b>; \n<i>Posted: 13 Dec 2019<\/i>; \n<b>Reviewer #2&nbsp;<\/b>(Joaquin M. Prada) &nbsp; \n<b>Reviewer\u2019s summary.<\/b> This paper summarizes the opinions of a group of mathematical modellers, veterinarians and clinical experts regarding the WHO 2030 goals for the control of cysticercosis. The manuscript is clear and well written and is illustrated by the outputs, from recent publications, of the mathematical models that the authors have developed. \n<b>Authors\u2019 response to summary. <\/b>We thank the reviewer for these comments. &nbsp; \n<b>Reviewer\u2019s comment 2.1. <\/b>My only comment is clarification on the figures' units for the y-axis (I do take the point that these figures have been extracted as they were from previous work). Figure 1 label states percentage, but the axis is from 0 to 1. Figures 2 and 3 just state \u201cprevalence\u201d in the y-axis (prevalence is often showed as a percentage, but the axis might suggest it is being shown as a proportion?). I would recommend either changing the axis to be between 0 to 100%, or clarify in the labels which ones are proportions and\/or percentages. \n<b>Authors\u2019 response. 2.1. <\/b>We thank the reviewer for these comments, and acknowledge the points raised; however, as the reviewer notes, these figures are extracted from previous publications and therefore difficult to modify. We have, as suggested, provided clarification in the figure legends as follows:  \n<i>\u201c<\/i>\n<b><i>Figure 1. <\/i><\/b>\n<b><i>Impact of single interventions on the number of human cysticercosis cases<\/i><\/b>\n<i>. Box and whiskers represent the range of impact estimates from 1000 sensitivity draws of intervention efficacy parameters, the midline represents the median impact (on proportion of Human Cysticercosis cases prevented), the hinges the 25<sup>th<\/sup> and 75<sup>th<\/sup> percentiles, and the whiskers the range. Points show individual run outputs. Due to the large amount of uncertainty in parameters estimates, the impact of parameter estimates was explored separately (see Fig. 4<\/i>\n<i> in Winskill et al.<sup>37<\/sup><\/i>\n<i>). This figure has been reproduced under the Creative Commons Attribution 4.0 International License (CC BY 4.0) from Winskill et al. [37].\u201d<\/i> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; \n<i>\u201c<\/i>\n<b><i>Figure 2. <\/i><\/b>\n<b><i>Simulation of various control scenarios for Taenia solium&nbsp;using cystiSim.<\/i><\/b>\n<i> The effectiveness of repeated mass drug administration (MDA) in humans (H) for taeniasis is compared with three-monthly interventions in pigs (P) involving vaccination and treatment, or a combination of pig interventions with strategic MDA in the human population after 1000 simulations (S). The impacts are shown on porcine cysticercosis (PC), immunity to T.&nbsp;solium infection in the pig population (PR), and human taeniasis (HT), with prevalence shown here as a proportion. The coloured areas delineate the 95% uncertainty intervals for prevalence (proportion). Pr(elim) indicates the predicted probability of elimination of transmission (EOT) in the given scenario. Four scenarios are simulated which involve: MDA only in humans (A\u2013D): annual treatments for 5 or 10 consecutive years (A and B, respectively), and biannual MDA for 5 or 10 consecutive years (C and D, respectively). Two scenarios involve pig-focussed interventions. Each included three-monthly vaccination and oxfendazole treatment of the pig population. The first involves: vaccination and treatment in pigs (E) for 3 years. The second (F) also involves pig interventions, but includes three human MDA rounds, at 6, 12, and 18 months after the initiation of the interventions in pigs, over a total period of 2 years. This figure has been reproduced with permission from Braae et al. [36]. <\/i> &nbsp; \u201c\n<b><i>Figure 3. <\/i><\/b>\n<b><i>cystiSim output for different intervention scenarios aiming for control and elimination of Taenia solium in Zambia.<\/i><\/b>\n<i> Interventions aiming for control (A) and elimination (B): Pr<sub>(elim)<\/sub>: probability of elimination of transmission (EOT) of porcine cysticercosis (PCC) and human taeniasis (HT), MDA: human mass drug administration (praziquantel), OXF: porcine mass drug administration (oxfendazole), VAC: porcine vaccination (TSOL18), XqY: total number of X iterations of the intervention given at intervals of Y months. Interventions are introduced after 200 months. This figure has been reproduced with permission from Gabriel et al. [43]. Y-axis shows prevalence as a proportion.\u201d<\/i> &nbsp; \n<b>Reviewer\u2019s comment 2.2. <\/b>The references in the figure labels also need to be corrected. Figure 1 references Winskill&nbsp;\n<i>et al.<\/i>&nbsp;as ref 23, but I believe it is ref 34. Similarly in Figures 2 &amp; 3: Brae&nbsp;\n<i>et al.<\/i>&nbsp;Ref 31 and Gabri&euml;l&nbsp;\n<i>et al.<\/i>&nbsp;ref 25, when I believe those are ref 33 and ref 37 respectively. I would suggest re-checking all the references throughout to make sure they are correct.  \n<b>Authors\u2019 response. 2.2. <\/b>We thank the reviewer for highlighting these discrepancies. We have checked and modified the reference numbers in the revised manuscript also accounting for the fact that other reviewers have suggested inclusion of additional references.","URL":"https:\/\/gatesopenresearch.org\/articles\/3-1546\/v2#referee-comment-3256","order":3,"name":"referee-comment-3256","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/gatesopenres.14200.r27945, Kabemba Evans Mwape, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia, 21 Oct 2019, version 1, indexed","URL":"https:\/\/gatesopenresearch.org\/articles\/3-1546\/v1#referee-response-27945","order":4,"name":"referee-response-27945","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Maria-Gloria Basanez<\/b>; \n<i>Posted: 13 Dec 2019<\/i>; \n<b>Reviewer #3&nbsp;<\/b>(Kabemba Evans Mwape) &nbsp; \n<b>Reviewer\u2019s summary.<\/b> This paper is well written and very interesting to read as it brings to the fore what could probably be a huge milestone towards the control of&nbsp;\n<i>Taenia solium<\/i>, mathematical modelling of the transmission dynamics of the parasite. A robust transmission model is urgently needed in order to achieve the 2030 goals with regards&nbsp;\n<i>T. solium<\/i>&nbsp;control. It is encouraging that the cystiSim and EPICYST groups have teamed up to form CystiTeam. It is hoped that together with epidemiologists, veterinarians, clinicians, one health experts and program stakeholders, a model that clearly shows the effects of the various control on the parasite will be developed. \n<b>Authors\u2019 response. <\/b>We thank the reviewer for these positive and encouraging comments, and agree that this collaboration is an important step towards developing robust models to investigate control options. &nbsp; \n<b>Reviewer\u2019s comment 3.1. <\/b>Figure 2 clearly shows whether elimination of transmission can be achieved with the given control options including the frequency of implementation. My comment on this figure is to request that figure 2 E and F be enlarged to be the same size as the other figures, they seem smaller than A, B, C, D, E. \n<b>Authors\u2019 response. 3.1. <\/b>We thank the reviewer for these suggestions. However we are unable to edit the original files as the figures were taken from previous publications. &nbsp; \n<b>Reviewer\u2019s comment 3.2. <\/b>Lastly, I would like to urge the authors to recheck the references as some of them do not tally e.g. reference number 31 should be changed to&nbsp;34, the number in the text does not tally with the one on the list of references. \n<b>Authors\u2019 response. 3.2. <\/b>We thank the reviewer for highlighting the referencing discrepancies (see also response to 2.2); these are corrected in the revised manuscript.","URL":"https:\/\/gatesopenresearch.org\/articles\/3-1546\/v2#referee-comment-3257","order":5,"name":"referee-comment-3257","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This work was supported by the Bill and Melinda Gates Foundation through funding to the NTD Modelling Consortium [OPP1184344 to MW and MGB] and past funding to UCB, MVJ, VS, ASW, and WEH [1017886].\n\nMAD is funded by the Medical Research Council Doctoral Training Programme (MRC DTP). MAD, PW and MGB acknowledge joint Centre funding from the UK Medical Research Council and Department for International Development [MR\/R015600\/1]. VS and ASW acknowledge joint funding from the German Federal Ministry of Education and Research (BMBF) [CYSTINET\u2013Africa 01KA1618 and SOLID 01KA1617]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":6,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}