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Mwesigwa J, Slater H, Bradley J, Saidy B, Ceesay F, Whittaker C, Kandeh B, Nkwakamna D, Drakeley C, Van Geertruyden JP, Bousema T, Achan J, D’Alessandro U. Field performance of the malaria highly sensitive rapid diagnostic test in a setting of varying malaria transmission. Malar J 2019; 18:288. [PMID: 31455349 PMCID: PMC6712604 DOI: 10.1186/s12936-019-2929-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 08/22/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The Gambia has successfully reduced malaria transmission. The human reservoir of infection could further decrease if malaria-infected individuals could be identified by highly sensitive, field-based, diagnostic tools and then treated. METHODS A cross-sectional survey was done at the peak of the 2017 malaria season in 47 Gambian villages. From each village, 100 residents were randomly selected for finger-prick blood samples to detect Plasmodium falciparum infections using highly sensitive rapid diagnostic tests (HS-RDT) and PCR. The sensitivity and specificity of the HS-RDT were estimated (assuming PCR as the gold standard) across varying transmission intensities and in different age groups. A deterministic, age-structured, dynamic model of malaria transmission was used to estimate the impact of mass testing and treatment (MTAT) with HS-RDT in four different scenarios of malaria prevalence by PCR: 5, 15, 30, and 60%, and with seasonal transmission. The impact was compared both to MTAT with conventional RDT and mass drug administration (MDA). RESULTS Malaria prevalence by HS-RDT was 15% (570/3798; 95% CI 13.9-16.1). The HS-RDT sensitivity and specificity were 38.4% (191/497, 95% CI 34.2-42.71) and 88.5% (2922/3301; 95% CI 87.4-89.6), respectively. Sensitivity was the highest (50.9%, 95% CI 43.3-58.5%) in high prevalence villages (20-50% by PCR). The model predicted that in very low transmission areas (≤ 5%), three monthly rounds of MTAT with HS-RDT, starting towards the end of the dry season and testing 65 or 85% of the population for 2 consecutive years, would avert 62 or 78% of malaria cases (over 2 years), respectively. The effect of the intervention would be lower in a moderate transmission setting. In all settings, MDA would be superior to MTAT with HS-RDT which would be superior to MTAT with conventional RDT. CONCLUSION The HS-RDT's field sensitivity was modest and varied by transmission intensity. In low to very low transmission areas, three monthly rounds per year of MTAT with HS-RDT at 85% coverage for 2 consecutive years would reduce malaria prevalence to such low levels that additional strategies may achieve elimination. The model prediction would need to be confirmed by cluster-randomized trials.
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Affiliation(s)
- Julia Mwesigwa
- 0000 0004 0606 294Xgrid.415063.5Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
| | - Hannah Slater
- 0000 0001 2113 8111grid.7445.2MRC Centre for Global Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, Norfolk Place, London, W2 1P UK ,0000 0000 8940 7771grid.415269.dPATH, 2201 Westlake Avenue, Seattle, USA
| | - John Bradley
- 0000 0004 0425 469Xgrid.8991.9MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Binta Saidy
- 0000 0004 0606 294Xgrid.415063.5Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
| | - Fatima Ceesay
- 0000 0004 0606 294Xgrid.415063.5Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
| | - Charles Whittaker
- 0000 0001 2113 8111grid.7445.2MRC Centre for Global Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, Norfolk Place, London, W2 1P UK
| | | | - Davis Nkwakamna
- 0000 0004 0606 294Xgrid.415063.5Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
| | - Chris Drakeley
- 0000 0004 0425 469Xgrid.8991.9Department of Immunology and Infection, Faculty of Infectious Diseases and Tropical Medicine, London School of Hygiene and Tropical Medicine, London, UK
| | - Jean-Pierre Van Geertruyden
- 0000 0001 0790 3681grid.5284.bFaculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Teun Bousema
- 0000 0004 0444 9382grid.10417.33Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jane Achan
- 0000 0004 0606 294Xgrid.415063.5Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
| | - Umberto D’Alessandro
- 0000 0004 0606 294Xgrid.415063.5Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
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