Lessons learned from the use of HRP-2 based rapid diagnostic test in community-wide screening and treatment of asymptomatic carriers of Plasmodium falciparum in Burkina Faso

Malaria Journal

Research

Sam Coulibaly¹  Alphonse Ouédraogo¹  Issiaka Soulama¹  Aïssata Barry¹  Alfred B Tiono¹  Amadou T Konaté¹  Amidou Diarra¹  Sodiomon B Sirima¹  Amitava Mukhopadhyay²  Kamal Hamed³ 

[1] Centre National de Recherche et de Formation sur le Paludisme (CNRFP), 01 BP 2208, Ouagadougou 01, Burkina Faso, West Africa;Novartis Healthcare Private Limited, 500081, Hyderabad, India;Novartis Pharmaceuticals Corporation, One Health Plaza, 07936-1080, East Hanover, NJ, USA;

关键词: Malaria;    Plasmodium falciparum;    Asymptomatic carriers;    Community screening;    Rapid diagnostic tests;   

DOI  :  10.1186/1475-2875-13-30

 received in 2013-09-25, accepted in 2014-01-22,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundRapid diagnostic tests (RDTs) are immune chromatographic tests targeting antigens of one or more Plasmodium species and offer the potential to extend accurate malaria diagnosis in endemic areas. In this study, the performance of Plasmodium falciparum- specific histidine-rich protein-2 (PfHRP-2) RDT in the detection of asymptomatic carriers from a hyperendemic region of Burkina Faso was compared with microscopy to gain further insight on its relevance in community-based interventions.MethodsThe performance of HRP-2 test was evaluated in terms of sensitivity, specificity, positive and negative predictive values, discordant values, likelihood ratios, accuracy, and precision using microscopy as the 'gold standard’. This analysis was carried out in a controlled, parallel, cluster-randomized (18 clusters; 1:1) study in children and adults. The effect of systematic treatment of P. falciparum asymptomatic carriers during three consecutive monthly community screening campaigns on the incidence of symptomatic malaria episodes over a 12-month period was compared with no treatment of asymptomatic carriers.ResultsSensitivity of HRP-2 test in asymptomatic carriers was higher in campaign 1 (92.4%) when compared to campaign 2 (84.0%) and campaign 3 (77.8%). The sensitivity of HRP-2 test increased as parasite density increased across all the age groups. Highest sensitivity (≥97.0%) was recorded at parasite densities of 1,000-4,999/μl, except for children aged 10 to 14 years. The specificity of HRP-2 test was comparable across age groups and highest in campaign 3 (95.9%). The negative predictive values were high across the three campaigns (≥92.7%) while the positive predictive values ranged from 23.2 to 73.8%. False-positive and false-negative rates were high in campaign 1 and campaign 3, respectively.ConclusionThe performance of HRP-2 test in detecting asymptomatic carriers of P. falciparum varied by age and parasite density. Although the use of HRP-2 test is beneficial for the diagnosis of acute malaria, its low sensitivity in screening asymptomatic carriers may limit its utility in pre-elimination interventional settings. The use of a practical and more sensitive test such as loop-mediated isothermal amplification in combination with a cost effective HRP-2 test may be worth exploring in such settings.

【 授权许可】

CC BY   
© Tiono et al.; licensee BioMed Central Ltd. 2014