Detection of malaria parasitemia for hotspot identification: employment of loop-mediated isothermal amplification (LAMP) in remote clinics in Kenya

Abstract

Background: Identification of asymptomatic populations that may be reservoirs for malaria transmission is key to ensuring eradication. The lack of ability of current diagnostic tools to screen for asymptomatic malaria infection at a field level has made identification of these hotspots of transmission difficult. Molecular methods necessary to detect the low-density parasitemia in asymptomatic malaria, such as polymerase chain reaction (PCR), require considerable training to perform and remain too complex for use in field. Loop-mediated isothermal amplification (LAMP) has proven a cost-effective technique for identifying asymptomatic malaria in resource-limited field settings. Structure/Method/Design: Student scientists from UC Berkeley and faculty from UC San Francisco Malaria Elimination Initiative informed research scientists at Maceno University about the use of LAMP to detect malaria parasitemia in asymptomatic cases. Early results indicate progress in the use of LAMP for the creation of a hotspot identificationmap, whichwill be completed by January 2015. The UC Berkeley-UC San FranciscoMaceno University collaboration continues to build capacity of local research scientists to perform the experimental phase of a hotspot identification campaign and, by default, gain understanding on the evolution of the Plasmodium parasite, change in its species, and hotspot characterization. Results (Scientific Abstract)/Collaborative Partners (Programmatic Abstract): University of Califonia, San Francisco Global Health Group & Malaria Elimination Initiative Maceno University Kenya Dr. Eva Harris, UC Berkeley Summary/Conclusion: Berkeley students have trained interested clinicians in LAMP diagnostics. They have compared successful diagnoses obtained using former RDT methods alongside LAMP tests to determine differences in detection capabilities that have been conveyed to clinicians and researchers. This has been instrumental in identifying asymptomatic populations and building an efficient drug distribution model for targeted ACT treatment. Data has been collected regarding trends of infection, efficacy of LAMP testing, and potential areas for improvement at every step in our initiative. ACT treatment of individuals who test positive for malaria via LAMP tests will begin as soon as possible, and as will the analysis of whether this corresponds with a drop in infection rates. A local team is carrying out experiments year round to test for variations in P. falciparum populations or emergence of drug-resistant strains, which will provide important information about fluctuations in parasite populations and emergence of drugresistant strains that can be used to tailor anti-malarial strategies.