In order to improve the diagnostic accuracy even more when the OV-ES assay is used in low transmission scenarios, one possibility is to modify the current protocol to increase volume of the urine sample in the assay. In the current protocol, we used 100 μL of sample diluted in 4% TCA, with only 50 μL of urine sample was used. A similar strategy has been successfully investigated in detecting circulating antigen in urine in Asian schistosomiasis (Schistosoma japonicum) in which the results showed that by increasing volume of urine sample from
250 μL to 2 mL of urine, the diagnostic sensitivity has increased 5 folds [44, 45].