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EVALUATION OF THREE RAPID TESTS FOR DIAGNOSIS OF P. FALCIPARUM AND P. VIVAX MALARIA IN COLOMBIA

The diagnostic capacity of three malaria rapid diagnostic tests (RDTs), NOW-Malaria-ICT, OptiMAL-IT, and Paracheck-Pf, was evaluated against expert microscopy in Colombia. We tested 896 patients, of whom microscopy confirmed 139 P. falciparum, 279 P. vivax, and 13 mixed P.f/P.v infections and 465 negatives. Paracheck-Pf and NOW-malaria-ICT were more accurate in detecting P. falciparum (sensitivities 90.8% and 90.1%, respectively) in comparison with Optimal-IT (83.6%). NOW showed an acceptable Pf detection rate at low densities (< 500/µL), but resulted in a higher proportion of false positives. For P. vivax diagnosis, Optimal-IT had a higher sensitivity than NOW (91.0% and 81.4%, respectively). The choice between the two Pf/Pv detecting RDTs balances P. falciparum and P. vivax detection rates. Considering some degree of P. falciparum overtreatment and failure to detect all P. vivax cases as more acceptable than missing some cases of P. falciparum, we recommend careful implementation of NOW-malaria-ICT in areas where microscopy is lacking. The price is however still a constraint.

Received April 8, 2006. Accepted for publication August 14, 2006.

Acknowledgments: The authors thank the Médecins sans Frontières (MSF) team in Tierralta who did all the work, and for input and feedback from other MSF staff in Monteria and Bogota. Support from Dr. Unni Karunakara and Dr. Ilse Broek, Health Advisors, MSF-Holland, Amsterdam was highly appreciated. We also thank Dr. Sylvia Blair and Dr. Jaime Carmona Fonseca of the University of Antioquia and Dr. Rubén Santiago Nicholls of the National Institute of Health, Bogotá, Colombia, for their help.

The authors have no conflict of interest to declare.

Financial support: The study was sponsored by MSF-Holland and its donors. The rapid tests were studied independently and purchased commercially from their manufacturers. The American Society of Tropical Medicine and Hygiene (ASTMH) assisted with publication expenses.

^* Address correspondence to Ingrid van den Broek, Manson Unit, MSF-UK, 67–74 Saffron Hill, EC1N 8QX London, UK, E-mail: Ingrid_vandenbroek{at}yahoo.com

Authors’ addresses: Ingrid van den Broek, Prudence Hamade, and Helen Counihan, Manson Unit, MSF-UK, 67–74 Saffron Hill, EC1N 8QX London, UK, E-mail: Ingrid_vandenbroek{at}yahoo.com. Olivia Hill, Fabiola Gordillo, and Bibiana Angarita, MSF-Holland, Calle 37, 16–64 Teusaquillo, Bogotá, Colombia. Jean-Paul Guthmann, Epicentre, 62 bis Boulevard Richard Lenoir, 75011, Paris, France.

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