Scale-up of Malaria Rapid Diagnostic Tests and Artemisinin-Based Combination Therapy: Challenges and Perspectives in Sub-Saharan Africa

Bastiaens, Guido J. H.; Bousema, Teun; Leslie, Toby

doi:10.1371/journal.pmed.1001590

Cited by 85 publications

(93 citation statements)

References 46 publications

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“…In this study, all the Malawi [30], found that prescribing anti-malaria drugs to only patients that tested positive after parasitological examination of the blood reduced the total number of anti-malaria medicine prescriptions; and by extension the quantity of anti-malaria drugs consumed in a community. Furthermore, introduction of mRDTs in places where malaria diagnosis was usually through presumptive method, demonstrated significant reduction in over prescription of anti-malaria drugs [31]. One would have thought that all medically qualified personnel ought to have been conversant with this apparently deducible finding.…”

Section: Discussionmentioning

confidence: 99%

Knowledge and Perception of Malaria Rapid Diagnostic Test among Medical Doctors in a South Eastern Nigeria Tertiary Hospital

Ndibuagu¹,

Amadi²,

Ugwu³

2017

JBM

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Malaria commonly causes fever in tropical Africa. In 2010, World Health Organization recommended parasitological diagnosis of malaria before treatment. Rapid Diagnostic Test (RDT) aims at making malaria diagnosis more accessible. The objective of this study was to assess knowledge, and perception of malaria rapid diagnostic test (mRDT), among doctors in a tertiary health facility. A descriptive, cross sectional study, conducted in October 2016, in a state University Teaching hospital, Enugu state, Nigeria. 86 doctors in the General Outpatient, Internal Medicine, and Paediatrics departments participated. 90.7% of respondents knew parasitological examination of blood is the certain method of making malaria diagnosis, 89.5% knew microscopy and RDT are methods for parasitological diagnosis, 91.9% knew mRDT is quick blood test for malaria, 54.7% knew mRDT is usually specific for one or more species of malaria, 46.5% knew mRDT detects circulating malaria parasite antigen, 29.1% knew mRDT is read 15 to 20 minutes after the test, 70.9% knew mRDT is not superior to microscopy, 79.1% knew mRDT is not 100% specific, 80.2% knew mRDT ought not be done always by Laboratory Scientists, and 66.3% knew more than one type of mRDT kit is available. On perception, 64.0% thought it was important to confirm diagnosis before commencing treatment, 90.7% perceived mRDT as being very useful, 96.5% did not perceive mRDT as endangering patients, 70.9% opinioned that presumptive diagnosis of malaria is not a better way of making diagnosis, 76.7% did not believe malaria diagnosis is always clear on listening to the patient, 90.7% did not perceive mRDT as being hazardous, 83.7% believe using mRDT can reduce the quantity of anti-malaria drugs consumed, and 94.2% opinioned that mRDT should be encouraged and promoted. Training and re-training of health workers shall greatly enhance mRDT use in implementing the WHO How to cite this paper: Ndibuagu, E.O.,

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Section: Discussionmentioning

confidence: 99%

Knowledge and Perception of Malaria Rapid Diagnostic Test among Medical Doctors in a South Eastern Nigeria Tertiary Hospital

Ndibuagu¹,

Amadi²,

Ugwu³

2017

JBM

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“…From a public health perspective, RDTs have the potential to improve the case management of febrile illness and slow the development of resistance to ACT by decreasing the number of inappropriate prescriptions (7,8). Additionally, the diagnostic accuracy of RDTs should conceivably motivate recognition and treatment of alternative causes of febrile illness (9) as well as improve the quality of communicable disease surveillance (10).…”

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confidence: 99%

Improving the Specificity of Plasmodium falciparum Malaria Diagnosis in High-Transmission Settings with a Two-Step Rapid Diagnostic Test and Microscopy Algorithm

et al. 2017

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Poor specificity may negatively impact rapid diagnostic test (RDT)-based diagnostic strategies for malaria. We performed real-time PCR on a subset of subjects who had undergone diagnostic testing with a multiple-antigen (histidine-rich protein 2 and pan-lactate dehydrogenase pLDH [HRP2/pLDH]) RDT and microscopy. We determined the sensitivity and specificity of the RDT in comparison to results of PCR for the detection of Plasmodium falciparum malaria. We developed and evaluated a two-step algorithm utilizing the multiple-antigen RDT to screen patients, followed by confirmatory microscopy for those individuals with HRP2-positive (HRP2 ϩ )/ pLDH-negative (pLDH Ϫ ) results. In total, dried blood spots (DBS) were collected from 276 individuals. There were 124 (44.9%) individuals with an HRP2 ϩ /pLDH ϩ result, 94 (34.1%) with an HRP2 ϩ /pLDH Ϫ result, and 58 (21%) with a negative RDT result. The sensitivity and specificity of the RDT compared to results with real-time PCR were 99.4% (95% confidence interval [CI], 95.9 to 100.0%) and 46.7% (95% CI, 37.7 to 55.9%), respectively. Of the 94 HRP2 ϩ /pLDH Ϫ results, only 32 (34.0%) and 35 (37.2%) were positive by microscopy and PCR, respectively. The sensitivity and specificity of the two-step algorithm compared to results with real-time PCR were 95.5% (95% CI, 90.5 to 98.0%) and 91.0% (95% CI, 84.1 to 95.2), respectively. HRP2 antigen bands demonstrated poor specificity for the diagnosis of malaria compared to that of realtime PCR in a high-transmission setting. The most likely explanation for this finding is the persistence of HRP2 antigenemia following treatment of an acute infection. The two-step diagnostic algorithm utilizing microscopy as a confirmatory test for indeterminate HRP2 ϩ /pLDH Ϫ results showed significantly improved specificity with little loss of sensitivity in a high-transmission setting.KEYWORDS Plasmodium falciparum, antigen specificity, diagnostics, epidemiology, malaria, rapid tests S ince 2010, the World Health Organization (WHO) has recommended that all suspected malaria cases have a parasite-based diagnosis, either by microscopy or a rapid diagnostic test (RDT), prior to treatment with artemisinin-based combination therapy (ACT) (1). While light microscopy is the traditional reference standard for the diagnosis of malaria, RDTs are increasingly employed because they require minimal Improving the specificity of Plasmodium falciparum malaria diagnosis in hightransmission settings with a two-step rapid diagnostic test and microscopy algorithm. J

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“…The fact that most people who tested negative on the RDT decided to still take AL also suggests that patients may have lacked confidence in the RDT result. Though our study design is likely to have biased RDT-negative patients toward taking the medicines, several other studies, across different contexts, have also found high prescription and purchase rates of ACTs despite a negative test result, 28,[48][49][50] likely because there is a tendency in malariaendemic areas for both health workers and patients to treat all fever episodes as malaria. [51][52][53] It may be that over time, as patients learn about the accuracy of the test, RDTs will have a greater impact on adherence.…”

Section: Discussionmentioning

confidence: 89%

“…23 Since the symptoms of malaria overlap with several common diseases such as pneumonia, as well as other bacterial and viral infections, [24][25][26] untested patients may face significant uncertainty over whether the illness they are suffering from is malaria, particularly in contexts where they have less confidence in the provider's ability to clinically diagnose the disease. [27][28][29][30] If the practice of stopping medication mid-treatment is related to this uncertainty, then a confirmed malaria diagnosis could encourage patients to complete the treatment.…”

Section: Introductionmentioning

confidence: 99%

Can Rapid Diagnostic Testing for Malaria Increase Adherence to Artemether–Lumefantrine?: A Randomized Controlled Trial in Uganda

Saran¹,

Yavuz²,

Kasozi³

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Most patients with suspected malaria do not receive diagnostic confirmation before beginning antimalarial treatment. We investigated the extent to which uncertainty about malaria diagnosis contributes to patient nonadherence to artemether-lumefantrine (AL) treatment through a randomized controlled trial in central Uganda. Among 1,525 patients purchasing a course of AL at private drug shops, we randomly offered 37.6% a free malaria rapid diagnostic test (RDT) and then assessed adherence through home visits 3 days later. Of these subjects, 68.4% tested positive for malaria and 65.8% adhered overall. Patients who tested positive did not have significantly higher odds of adherence than those who were not offered the test (adjusted odds ratio [OR]: 1.07, 95% confidence interval [CI]: 0.734-1.57, P = 0.719). Patients who received a positive malaria test had 0.488 fewer pills remaining than those not offered the test (95% CI: −1.02 to 0.043, P = 0.072). We found that patients who felt relatively healthy by the second day of treatment had lower odds of completing treatment (adjusted OR: 0.532, 95% CI: 0.394-0.719, P < 0.001). Our results suggest that diagnostic testing may not improve artemisinin-based combination therapy adherence unless efforts are made to persuade patients to continue taking the full course of drugs even if symptoms have resolved.

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Scale-up of Malaria Rapid Diagnostic Tests and Artemisinin-Based Combination Therapy: Challenges and Perspectives in Sub-Saharan Africa

Abstract: Guido Bastiaens and colleagues describe barriers to achieving scale-up and appropriate use of rapid diagnostic tests and artemisinin-based combination therapy for malaria in sub-Saharan Africa. Please see later in the article for the Editors' Summary

Cited by 85 publications

References 46 publications

Knowledge and Perception of Malaria Rapid Diagnostic Test among Medical Doctors in a South Eastern Nigeria Tertiary Hospital

Knowledge and Perception of Malaria Rapid Diagnostic Test among Medical Doctors in a South Eastern Nigeria Tertiary Hospital

Improving the Specificity of Plasmodium falciparum Malaria Diagnosis in High-Transmission Settings with a Two-Step Rapid Diagnostic Test and Microscopy Algorithm

Can Rapid Diagnostic Testing for Malaria Increase Adherence to Artemether–Lumefantrine?: A Randomized Controlled Trial in Uganda

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