Estimating the Added Utility of Highly Sensitive Histidine-Rich Protein 2 Detection in Outpatient Clinics in Sub-Saharan Africa

Mateusz M. Plucinski Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia;
U.S. President’s Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia;

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Eric Rogier Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia;

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Pedro Rafael Dimbu National Malaria Control Program, Ministry of Health, Luanda, Angola

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Filomeno Fortes National Malaria Control Program, Ministry of Health, Luanda, Angola

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Eric S. Halsey Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia;
U.S. President’s Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia;

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Michael Aidoo Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia;

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DOI:
https://doi.org/10.4269/ajtmh.17-0262
Volume/Issue:
Volume 97: Issue 4
Page(s):
1159–1162
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Most malaria testing is by rapid diagnostic tests (RDTs) that detect Plasmodium falciparum histidine-rich protein 2 (HRP2). Recently, several RDT manufacturers have developed highly sensitive RDTs (hsRDTs), promising a limit of detection (LOD) orders of magnitude lower than conventional RDTs. To model the added utility of hsRDTs, HRP2 concentration in Angolan outpatients was measured quantitatively using an ultrasensitive bead-based assay. The distribution of HRP2 concentration was bimodal in both afebrile and febrile patients. The conventional RDT was able to detect 81% of all HRP2-positive febrile patients and 52–77% of HRP2-positive afebrile patients. The added utility of hsRDTs was estimated to be greater in afebrile patients, where an hsRDT with a LOD of 200 pg/mL would detect an additional 50–60% of HRP2-positive persons compared with a conventional RDT with a LOD of 3,000 pg/mL. In febrile patients, the hsRDT would detect an additional 10–20% of cases. Conventional RDTs already capture the vast majority of symptomatic HRP2-positive individuals, and hsRDTs would have to reach a sufficiently low LOD approaching 200 pg/mL to provide added utility in identifying HRP2-positive, asymptomatic individuals.

Author Notes

Address correspondence to Mateusz M. Plucinski, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329-4018. E-mail: mplucinski@cdc.gov

Authors’ addresses: Mateusz M. Plucinski, Eric Rogier, Eric S. Halsey, and Michael Aidoo, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: mplucinski@cdc.gov, erogier@cdc.gov, ehalsey@cdc.gov, and maidoo@cdc.gov. Pedro Rafael Dimbu and Filomeno Fortes, National Malaria Control Program, Ministry of Health, Luanda, Angola, E-mails: rafaeldimbu1@gmail.com and filomenofortes@gmail.com.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2017
Received:
30 Mar 2017
|
Accepted:
07 May 2017
|
Published Online:
12 Jun 2017
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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