Utility of a Point-of-Care Malaria Rapid Diagnostic Test for Excluding Malaria as the Cause of Fever among HIV-Positive Adults in Rural Rakai, Uganda

Lisa A. Mills Johns Hopkins School of Medicine, Division of Infectious Diseases, Baltimore, Maryland; Rakai Health Sciences Program, Kalisizo, Uganda; Clinical Monitoring Research Program, SAIC-Frederick, Inc., NCI-Frederick, Frederick, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Makerere University Institute of Public Health, Kampala, Uganda; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

Search for other papers by Lisa A. Mills in
Current site
Google Scholar
PubMed
Close
,
Joseph Kagaayi Johns Hopkins School of Medicine, Division of Infectious Diseases, Baltimore, Maryland; Rakai Health Sciences Program, Kalisizo, Uganda; Clinical Monitoring Research Program, SAIC-Frederick, Inc., NCI-Frederick, Frederick, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Makerere University Institute of Public Health, Kampala, Uganda; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

Search for other papers by Joseph Kagaayi in
Current site
Google Scholar
PubMed
Close
,
Gertrude Nakigozi Johns Hopkins School of Medicine, Division of Infectious Diseases, Baltimore, Maryland; Rakai Health Sciences Program, Kalisizo, Uganda; Clinical Monitoring Research Program, SAIC-Frederick, Inc., NCI-Frederick, Frederick, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Makerere University Institute of Public Health, Kampala, Uganda; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

Search for other papers by Gertrude Nakigozi in
Current site
Google Scholar
PubMed
Close
,
Ronald M. Galiwango Johns Hopkins School of Medicine, Division of Infectious Diseases, Baltimore, Maryland; Rakai Health Sciences Program, Kalisizo, Uganda; Clinical Monitoring Research Program, SAIC-Frederick, Inc., NCI-Frederick, Frederick, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Makerere University Institute of Public Health, Kampala, Uganda; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

Search for other papers by Ronald M. Galiwango in
Current site
Google Scholar
PubMed
Close
,
Joseph Ouma Johns Hopkins School of Medicine, Division of Infectious Diseases, Baltimore, Maryland; Rakai Health Sciences Program, Kalisizo, Uganda; Clinical Monitoring Research Program, SAIC-Frederick, Inc., NCI-Frederick, Frederick, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Makerere University Institute of Public Health, Kampala, Uganda; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

Search for other papers by Joseph Ouma in
Current site
Google Scholar
PubMed
Close
,
Joseph P. Shott Johns Hopkins School of Medicine, Division of Infectious Diseases, Baltimore, Maryland; Rakai Health Sciences Program, Kalisizo, Uganda; Clinical Monitoring Research Program, SAIC-Frederick, Inc., NCI-Frederick, Frederick, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Makerere University Institute of Public Health, Kampala, Uganda; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

Search for other papers by Joseph P. Shott in
Current site
Google Scholar
PubMed
Close
,
Victor Ssempijja Johns Hopkins School of Medicine, Division of Infectious Diseases, Baltimore, Maryland; Rakai Health Sciences Program, Kalisizo, Uganda; Clinical Monitoring Research Program, SAIC-Frederick, Inc., NCI-Frederick, Frederick, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Makerere University Institute of Public Health, Kampala, Uganda; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

Search for other papers by Victor Ssempijja in
Current site
Google Scholar
PubMed
Close
,
Ronald H. Gray Johns Hopkins School of Medicine, Division of Infectious Diseases, Baltimore, Maryland; Rakai Health Sciences Program, Kalisizo, Uganda; Clinical Monitoring Research Program, SAIC-Frederick, Inc., NCI-Frederick, Frederick, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Makerere University Institute of Public Health, Kampala, Uganda; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

Search for other papers by Ronald H. Gray in
Current site
Google Scholar
PubMed
Close
,
Maria J. Wawer Johns Hopkins School of Medicine, Division of Infectious Diseases, Baltimore, Maryland; Rakai Health Sciences Program, Kalisizo, Uganda; Clinical Monitoring Research Program, SAIC-Frederick, Inc., NCI-Frederick, Frederick, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Makerere University Institute of Public Health, Kampala, Uganda; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

Search for other papers by Maria J. Wawer in
Current site
Google Scholar
PubMed
Close
,
David Serwadda Johns Hopkins School of Medicine, Division of Infectious Diseases, Baltimore, Maryland; Rakai Health Sciences Program, Kalisizo, Uganda; Clinical Monitoring Research Program, SAIC-Frederick, Inc., NCI-Frederick, Frederick, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Makerere University Institute of Public Health, Kampala, Uganda; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

Search for other papers by David Serwadda in
Current site
Google Scholar
PubMed
Close
,
Thomas C. Quinn Johns Hopkins School of Medicine, Division of Infectious Diseases, Baltimore, Maryland; Rakai Health Sciences Program, Kalisizo, Uganda; Clinical Monitoring Research Program, SAIC-Frederick, Inc., NCI-Frederick, Frederick, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Makerere University Institute of Public Health, Kampala, Uganda; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

Search for other papers by Thomas C. Quinn in
Current site
Google Scholar
PubMed
Close
, and
Steven J. Reynolds Johns Hopkins School of Medicine, Division of Infectious Diseases, Baltimore, Maryland; Rakai Health Sciences Program, Kalisizo, Uganda; Clinical Monitoring Research Program, SAIC-Frederick, Inc., NCI-Frederick, Frederick, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Makerere University Institute of Public Health, Kampala, Uganda; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

Search for other papers by Steven J. Reynolds in
Current site
Google Scholar
PubMed
Close
Restricted access

We compared results of a malaria rapid diagnostic test (Binax Now® Malaria, Binax-M, Inverness Medical Innovations, Inc., Waltham, MA) performed at rural mobile clinics in Uganda by clinicians evaluating febrile adult HIV patients to thick smear evaluated at a central laboratory by trained microscopists. Two hundred forty-six samples were analyzed, including 14 (5.7%) which were thick-smear positive for falciparum malaria. Sensitivity of Binax-M compared with thick smear was 85.7% (95% CI: 57.2–98.2), specificity 97.8% (95% CI: 94.9–99.3), positive and negative predictive values were 70.6% (95% CI: 44.0–89.7) and 99.1% (95% CI: 96.8–99.9), respectively. The rapid diagnostic test accurately ruled malaria “in or out” at the point-of-care, facilitating appropriate clinical management and averting unnecessary anti-malarial therapy.

Author Notes

*Address correspondence to Lisa A. Mills, Division of Infectious Diseases, Johns Hopkins Medical Institutions, 1830 East Monument Street, Room #401, Baltimore, MD 21287. E-mail: LMills@ke.cdc.gov

Financial support: This project has been funded in whole or in part with federal funds from the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, and the National Cancer Institute, National Institutes of Health, under Contract Number HHSN261200800001E.

Disclaimer: The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of any trade names, commercial products, or organizations imply endorsement by the U.S. Government.

Authors' addresses: Lisa A. Mills, Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD, E-mail: lmills@ke.cdc.gov. Joseph Kagaayi, Gertrude Nakigozi, Ronald M. Galiwango, Joseph Ouma, and Victor Ssempijja, Rakai Health Sciences Program, Kalisizo, Rakai District, Uganda, E-mails: JKagayi@rhsp.org, FTrudie@yahoo.com, RMGaliwango@rhsp.org, Oumaotobi@yahoo.com, and VSsempijja@gmail.com. Joseph P. Shott, SAIC-Frederick, Inc., Support to DIR/NIAID/NIH, Bethesda, MD, E-mail: ShottJ@mail.nih.gov. Maria J. Wawer and Ronald H. Gray, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mails: MWawer@jhsph.edu and RGray@jhsph.edu. David Serwadda, Makerere University Institute of Public Health, IPH Building—New Mulago Complex, Kampala, Uganda, E-mail: DSerwada@infocom.co.ug. Thomas C. Quinn and Steven J. Reynolds, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, E-mails: TQuinn@jhmi.edu and SJR@jhmi.edu.

  • 1.

    UNAIDS, 2008. UNAIDS Global Report, Figure 19, Executive Summary. Available at: http://data.unaids.org/pub/GlobalReport/2008/JC1511_GR08_ExecutiveSummary_en.pdf. Accessed March 21, 2009.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Ssekabira U, Bukirwa H, Hopkins H, Namagembe A, Weaver MR, Sebuyira LM, Quick L, Staedke S, Yeka A, Kiggundu M, Schneider G, McAdam K, Wabwire-Mangen F, Dorsey G, 2008. Improved malaria case management after integrated team-based training of health care workers in Uganda. Am J Trop Med Hyg 79: 826833.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Nankabirwa J, Zurovac D, Njogu JN, Rwakimari JB, Counihan H, Snow RW, Tibenderana JK, 2009. Malaria misdiagnosis in Uganda—implications for policy change. Malar J 8: 19.

  • 4.

    Mermin J, Ekwaru JP, Liechty CA, Were W, Downing R, Ransom R, Weidle P, Lule J, Coutinho A, Solberg P, 2006. Effect of co-trimoxazole prophylaxis, antiretroviral therapy, and insecticide-treated bednets on the frequency of malaria in HIV-1-infected adults in Uganda: a prospective cohort study. Lancet 367: 12561261.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Bell DR, Perkins MD, 2008. Making malaria testing relevant: beyond test purchase. Trans R Soc Trop Med Hyg 102: 10641066.

  • 6.

    WHO Regional Office for Africa, 2008. Uganda Country Profile. Available at: http://www.afro.who.int/malaria/country-profile/uganda.pdf. Accessed December 7, 2008.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Rakai District Health Management Information Systems, 2005. Rakai District Health Survey, Rakai District Publications, Rakai, Uganda.

  • 8.

    Uganda Bureau of Statistics and Macro International Incorporated, 2006. Uganda Demographic and Health Survey 2006. Calverton, MD: UBOS and Macro International Inc. Available at: http://www.measuredhs.com/pubs/pdf/FR194/FR194.pdf/. Accessed July 17, 2008.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Inverness Medical Innovations, Incorporated, 2009. Binax Now® Malaria International Product Insert. Available at: http://www.binax.com/pdf/IN660050%20%20Malaria%20OUS%20Insert%20Rev%201%20%20010208.pdf. Accessed March 29, 2009.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    World Health Organization, 1991. Basic Malaria Microscopy, Part 1: Learner's Guide. Geneva: World Health Organization.

  • 11.

    Mayxay M, Pukrittayakamee S, Chotivanich K, Looareesuwan S, White NJ, 2001. Persistence of Plasmodium falciparum HRP-2 in successfully treated acute falciparum malaria. Trans R Soc Trop Med Hyg 95: 179182.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 100 97 16
Full Text Views 282 9 0
PDF Downloads 58 7 2
 
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save