Abstract
BackgroundMalaria diagnosis among HIV-positive patients is uncommon in Nigeria despite the high burden of both diseases.ObjectivesWe evaluated the performance of a malaria rapid diagnostic test (MRDT) against blood smear microscopy (BSM) among HIV-positive patients in relation to anti-retroviral treatment (ART) status, CD4+ count, fever, cotrimoxazole prophylaxis and malaria density count.MethodA cross-sectional study involving 1521 consenting randomly selected HIV-positive adults attending two ART clinics in Kano, Nigeria, between June 2015 and May 2016. Venous blood samples were collected for testing with MRDT, BSM, and CD4+ T cells count by cytometry. Biodata and other clinical details were extracted from patient folders into an Excel file, cleaned, validated, and exported for analysis into SPSS version 23.0. Sensitivity, specificity, predictive values of MRDT were compared with BSM with a 95% confidence interval.ResultsMalaria parasites were detected in 25.4% of enrollees by BSM and 16.4% by MRDT. Overall sensitivity of MRDT was 58% and specificity was 97%. Cotrimoxazole prophylaxis and fever status did not affect MRDT sensitivity and specificity. Unexpectedly, the sensitivity was highest at parasite density count of less than 500 cells/µL. At CD4+ T cells count over 500 cells/µL the sensitivity was higher (62.4%) compared to 56% at less than 500 cells/µL. In the non-ART group sensitivity was higher (65%) compared to those on ART (56%) but the specificity was similar. All differences were significant for all variables (p < 0.05).ConclusionAlthough the MRDT specificity was good, the sensitivity was poor, requiring further evaluation for use in malaria diagnosis among HIV-malaria co-infected persons in these settings.
Highlights
Malaria remains a major public health problem in Nigeria with 97% of the population at risk.[1]
2 and Plasmodium lactate dehydrogenase, is lower than World Health Organization (WHO) recommendation for malaria RDT (MRDT).[48]
Further evaluation is required to determine its suitability in malaria diagnosis among HIV-malaria co-infected patients in these settings
Summary
Malaria remains a major public health problem in Nigeria with 97% of the population at risk.[1]. A key factor for effective management of malaria is early and accurate diagnosis. The global impact of malaria has prompted an increase in the development of diagnostic strategies. The updated World Health Organization (WHO) recommendations indicate that all suspected cases of malaria must be confirmed with a laboratory diagnostic test before treatment.[8] This enables differentiation of malarial and non-malarial fevers, to prevent unnecessary use of antimalarial drugs.[9,10] This is very crucial among HIV-positive patients, where febrile illnesses other than malaria are common. Opportunistic infections and other febrile illnesses mimic malaria in HIV patients.[5]. Malaria diagnosis among HIV-positive patients is uncommon in Nigeria despite the high burden of both diseases
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