Abstract
BackgroundIn malaria elimination settings, the very low levels of transmission now being attained present challenges that demand new strategies to identify and treat low-density infections in both symptomatic and asymptomatic populations. Accordingly, passive case detection activities need to be supplemented by active case detection (ACD) strategies with more sensitive diagnostic tools. Malaria rapid diagnostic tests (RDTs) have provided low- and middle-income countries with unprecedented access to malaria diagnostics. Nevertheless, conventional RDTs miss a potentially important proportion of sub-microscopic infections. Therefore, new combination highly sensitive (HS-)RDTs, able to detect low parasite densities and identify all infected individuals, could support countries implementing ACD strategies for radical cure to accelerate malaria elimination. To address this need, an on-line survey was conducted to gather information from malaria control programme representatives to guide the development of next-generation RDTs.ResultsMost of respondents confirmed that ACD was a common activity in their programmes (56/75; 75%). Although microscopy was the preferred method in case management and reactive case detection, RDTs were the primary diagnostic tests used in proactive case detection (31/75; 41%). In terms of preferences for species detection in a new combination HS-RDT, data was not one-directional. Survey respondents slightly preferred the Pf/Pv/Pan combination (42%; 21/50), while Pf/Pan was more popular among end-users. Survey respondents also valued a low-cost (< $1.00 USD), lightweight and portable test, able to detect asymptomatic infections and differentiate species, as well as provide immediate results that could be interpreted with the naked eye. In addition, respondents were open to new tests and even to replace the existing ones for ACD (63%; 47/75).ConclusionsThis survey provided valuable information on the use and current limitations of ACD, on the primary product characteristics for a next-generation combination HS-RDT to support ACD and radical cure, and on the potential adoption of such a test, if available, to support malaria elimination.
Highlights
In malaria elimination settings, the very low levels of transmission being attained present challenges that demand new strategies to identify and treat low-density infections in both symptomatic and asymptomatic populations
Almost three quarters of the participants in the survey were based in the World Health Organization (WHO) WHO Regional Office for Africa (AFRO) and PAHO regions (31/75; 41% and 25/75; 33%, respectively; Fig. 1a)
Results were compared with World Malaria Report (WMR) data [1] to understand how representative the survey data were
Summary
The very low levels of transmission being attained present challenges that demand new strategies to identify and treat low-density infections in both symptomatic and asymptomatic populations. New combination highly sensitive (HS-) RDTs, able to detect low parasite densities and identify all infected individuals, could support countries implementing ACD strategies for radical cure to accelerate malaria elimination. To address this need, an on-line survey was conducted to gather information from malaria control programme representatives to guide the development of nextgeneration RDTs. Malaria continues to be a significant public health concern, responsible for approximately 212 million new cases and 429,000 deaths in 2015 [1]. The very low levels of transmission being attained in many countries present new challenges that demand new strategies, such as active case detection (ACD), to identify and treat infections among populations who do not seek treatment [6]. ACD can consist of screening for fever followed by parasitological examination of all febrile patients or as parasitological examination of the target population without prior screening for fever’ [7]
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