Assessing the impact of next-generation rapid diagnostic tests on Plasmodium falciparum malaria elimination strategies

Abstract

P lasmodium falciparum malaria was responsible for an estimated 584,000 (range 367,000-755,000) deaths in 2013, most of which occurred in young children in sub-Saharan Africa 1 . Although the burden has reduced in response to global efforts to increase the provision of proven malaria interventions such as insecticide-treated bed nets and access to health care and treatment 1 , it remains high. One of the challenges in reducing malaria transmission is the long duration of infection in the human host, which in semi-immune individuals may persist for a year or more 2 . In particular, although infection often leads to disease in naive individuals, those with sufficient acquired immunity can harbour parasites -and hence be onwardly infectious to mosquitoes -without exhibiting symptoms 3 . One option for speeding the decline in transmission could be to target the asymptomatic reservoir of infection 4 by providing either periodic mass-screen-and-treat (MSAT) programmes, focal MSAT or a reactive strategy in which individuals living in the vicinity of an identified clinical case are screened and treated. However, the extent to which such strategies are able to reduce the infectious reservoir will depend on the extent to which the diagnostic used to identify infected individuals also detects those who are onwardly infectious. Another form of targeting could take place at the population level (for example a village) where mass interventions are deployed if the population prevalence *These authors contributed equally.

Comparison of diagnostics for the detection of asymptomatic Plasmodium falciparum infections to inform control and elimination strategies

“…These are driven by the maturity of the host's immune response, which may vary by age and by local transmission dynamics, such as seasonality, that can influence population-level immunity or within-host parasite behaviour. Therefore, defining infectivity in relation to parasite density is especially important; this is addressed further by Slater and colleagues in a companion paper in this supplement 69 . Once the contribution of asymptomatic individuals to the infectious reservoir is better defined, future analyses should ideally establish optimal detection limits of new diagnostics for use in control and elimination strategies.…”

A field-deployable mobile molecular diagnostic system for malaria at the point of need

“…The detection limit of ∼0.6 parasites/μL of the AnyMDx is comparable to the benchtop real-time PCR test (∼0.7 parasites/μL 45 ) and to the benchtop LAMP test (∼2 parasites/μL 9 ). This level of sensitivity is necessary for detecting the early-stage asymptomatic parasite carriers of low parasite densities 9, 46 , which are often missed by either the immunoassay based rapid diagnostic tests (RDTs, ∼100 parasites/μL 7 ) or microscopy (∼30-50 parasites/μL 7, 11 ). Thus, the AnyMDx system is able to deliver ultrasensitive and quantitative molecular answers for malaria infections in remote settings without supporting infrastructures.…”

Establishment of Simple and Routine Methods in Early Diagnosis of Gentamicin-Induced Kidney Injury Based on a Rat Model

“…In recent years, new biomarkers for kidney injury such as kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) have been extensively studied [26–32]. KIM-1, also known as T-cells immunoglobulin mucin-1 (TIM-1), is a type-I transmembrane glycoprotein.…”