Should countries implementing an artemisinin-based combination malaria treatment policy also introduce rapid diagnostic tests?

Abstract

Background: Within the context of increasing antimalarial costs and or decreasing malaria transmission, the importance of limiting antimalarial treatment to only those confirmed as having malaria parasites becomes paramount. This motivates for this assessment of the cost-effectiveness of routine use of rapid diagnostic tests (RDTs) as an integral part of deploying artemisinin-based combination therapies (ACTs).

Accuracy of Two Malaria Rapid Diagnostic Tests (RDTS) for Initial Diagnosis and Treatment Monitoring in a High Transmission Setting in Uganda

“…24 However, among children 5 years of age in high transmission settings, some investigators suggest that presumptive treatment of malaria may be more cost effective than RDTs given the high prevalence of malaria in this age group. 25 Economic factors may be weighed alongside other potential benefits of RDT use in decision-making for given regions.…”

‘As a clinician, you are not managing lab results, you are managing the patient’: How the enactment of malaria at health facilities in Cameroon compares with new WHO guidelines for the use of malaria tests

“…Although microscopy is considered to be the gold standard for malaria diagnosis (World Health Organisation, 2010), it has been found to be impractical in many remote and resource-poor settings due to its requirements for trained personnel, equipment, regular supply of reagents and continued quality assurance supervision (Bell & Peeling, 2006;Moody, 2002;Zikusooka et al, 2008). Rapid Diagnostic Tests (RDTs) are being promoted as a solution to these diagnostic challenges in settings with no or poor quality microscopy.…”

“…Rapid Diagnostic Tests (RDTs) are being promoted as a solution to these diagnostic challenges in settings with no or poor quality microscopy. Malaria RDTs have been found to be accurate under controlled conditions, easy to use and interpret and can be performed with basic training and equipment (Nankabirwa et al, 2009;Zikusooka et al, 2008). Several studies have also suggested RDTs can be cost-effective when compared with no testing or microscopy although this depends on the prevalence of malaria, costs of testing and treatment and critically whether the treatment prescribed is consistent with the outcome of the malaria test (Lubell et al, 2008;Shillcutt et al, 2008;Zikusooka et al, 2008;Zurovac et al, 2008).…”

Case management of malaria: Diagnosis

“…[11] Microscopy equipment quality and maintenance, and staining quality and technique are often suboptimal, especially in remote, poorly-resourced settings. [12] Quality of microscopic diagnosis can be highly variable. A study in a Mpumalanga Province malaria-risk area showed wide variation in positivity rates (6.3 -45.8%) of a set of 48 slides that was circulated among four diagnostic laboratories.…”