Trachoma, lymphatic filariasis, schistosomiasis, onchocerciasis, and soil-transmitted helminth infections are found in overlapping populations; are controlled through broadly similar, often complementary, strategies involving MDA; and are mapped and monitored by sampling individuals from the population-at-risk using strategies that are also broadly similar but different in detail. Programmes for their control and elimination require improved diagnostic tools to guide decisions on the required intensity, frequency, and duration of intervention and to conduct surveillance for re-emergence of infection after elimination. Similarities between target product profiles ( and ) suggest the feasibility and desirability of integration of diagnostic approaches.
In many areas in which NTDs are highly endemic, basic health infrastructure is sparse or non-existent, and there are few trained personnel. Local laboratories may not have access to refrigeration, reliable power, or piped water; have highly variable capacity for performing diagnostic assays; and the capacity they do have is in general insufficient to meet existing diagnostic requirements of local clinical services. They are therefore ill-equipped to take on the extra burden of generating data to feed into NTD elimination programmes without provision of additional money, staff, training, equipment, reagents, and utilities—or robust technologies that could perform well despite limitations to supply of these resources.
The ideal integrated system might therefore be a portable, self-contained diagnostics platform, capable of performing multiplex assays for several infections of interest on one or a small number of sample types. A system employing microfluidics (“lab-on-a-chip”) 
technology could fulfil these requirements. The platform should be able to simultaneously undertake multiple roles in different NTD control programmes, each of which might be at various points of evolution within a given population. For example, in a district that had been hyperendemic at baseline for trachoma, soil-transmitted helminths, and lymphatic filariasis but in which interventions had already been in progress for a number of years, the platform would be capable of accurately detecting reductions in ocular C. trachomatis
infection, whilst simultaneously measuring the prevalence of soil-transmitted helminth infection and monitoring for post-elimination re-emergence of lymphatic filariasis. Since diseases of potential interest will vary from one population to the next, a modular format would provide opportunities to swap diagnostic capacity for particular infections in and out of the platform according to global, regional, or local priority. For example, in onchocerciasis-endemic areas, the capacity to test for loaiasis at the same time as measuring the prevalence of O. volvulus
infection would benefit programmes 
. Equally, the platform should be adaptable for the assessment of the community prevalence of HIV infection, malaria parasitaemia or anti-malaria antibody, and/or seroprevalence of antibodies to measles, rubella, or hepatitis B surface antigen following vaccination campaigns.
Our vision can be conceptualised as the delivery of two linked components: a hardware module, on which samples will be processed, and various elements of software, including both the assays themselves and the algorithms to guide their use in the field. To ensure that any new technologies are ready for both registration and end use, field personnel, programme managers, regulatory agencies, ministries of health, and other key stakeholders should be involved in platform development and evaluation.
In addition to the potential savings to existing vertical control programmes that would become possible through integration of diagnostic tools, this approach has several other potential advantages.
First, it makes conducting surveys to rule out specific diseases easier and more cost-effective. This can occasionally yield surprising results. In Burundi in 2007, examination for trachoma was included alongside fieldwork conducted nationally to estimate the prevalences of schistosomiasis and soil-transmitted helminths, in order to confirm the long-held belief that Burundi was trachoma-free. Active trachoma was found in children throughout the country, and trachoma control activities including azithromycin MDA commenced in 2011 in three districts.
Second, proof-of-concept of an integrated diagnostics platform could facilitate programme planning for other infections for which control strategies are in the early stages of development. An October 2009 WHO expert consultation discussed recent work piloting taeniasis elimination in Peru and possible MDA approaches for food-borne trematode infections. These diseases may have global control initiatives developed in the foreseeable future.
Third, establishing capacity for reliable diagnosis of what have hitherto been the most neglected diseases could catalyse a frame-shift in the global health community's vision of developing world laboratory science. A diagnostics platform that could be configured to generate community- or individual-level data for any of the infections already mentioned as well as perform tests for (for example) sexually transmitted infections, human African trypanosomiasis, or leishmaniasis would represent a game-changing advance in the fight against infectious diseases.
World Health Assembly Resolution 60.29 on Health Technologies recognizes that medical devices are indispensable tools for prevention, diagnosis, treatment, and rehabilitation in health care 
. It is widely accepted that the availability of, and access to, appropriate and affordable health technologies in low- and middle-income countries remain inadequate. In 2010, WHO held the first Global Forum on Medical Devices 
, which featured selected technological innovations that could improve global health. The innovators identified financing, manufacturing partners, and distribution channels as their top three challenges in getting their technologies into resource-limited settings. WHO undertook to continue to interact with industry, funding agencies, academia, and international organizations to raise awareness of the need to design, produce, and commercialize innovative, accessible, and robust technologies which address the needs of health systems particularly in low-resource settings. The development, evaluation, and deployment of an integrated platform to monitor progress towards NTD elimination would be consistent with this WHO vision.