BACKGROUND: Schistosomiasis caused by Schistosoma japonicum remains a public health concern in low-endemic areas of Indonesia. Sensitive and field-applicable diagnostic tools are essential for effective surveillance and control. This study evaluated the diagnostic performance of a point-of-care circulating cathodic antigen (POC-CCA) urine test for detecting S. japonicum infection.

METHODS: A community-based cross-sectional diagnostic evaluation was conducted during August–September 2023 among 226 residents of Wanga (Lore Peore) and Tamadue (Lore Timur) villages, Poso Regency, Central Sulawesi, Indonesia. Stool samples were examined using the Kato–Katz (KK) technique, and urine samples were tested using the POC-CCA cassette. Diagnostic accuracy indices were calculated using MedCalc software, with KK serving as the reference standard.

RESULTS: Of the 226 participants, 36 (15.9%) were positive for S. japonicum by KK, whereas only 6 (2.7%) tested positive by POC-CCA. A total of 188 participants were negative by both methods, while 30 were KK-positive but POC-CCA–negative. The sensitivity of the POC-CCA test was 16.67% (95% CI: 6.37–32.81), and specificity was 98.95% (95% CI: 96.25–99.87). The positive predictive value was 75.00% (95% CI: 38.66–93.46), the negative predictive value was 86.24% (95% CI: 84.40–87.89), and Cohen’s kappa coefficient was 0.246 (95% CI: 0.004–0.487), indicating fair agreement.

CONCLUSIONS: The POC-CCA urine test demonstrated high specificity but very low sensitivity for detecting S. japonicum, particularly in low-intensity infections. Its use as a standalone diagnostic tool in low-endemic settings is not recommended. Refinement of the assay or integration with complementary diagnostic methods is necessary before field application.

KEYWORDS: Schistosomiasis; Schistosoma japonicum; POC-CCA; diagnostic accuracy; Indonesia