Modelling the incremental benefit of introducing malaria screening strategies to antenatal care in Africa

Patrick G. T. Walker (), Matt Cairns, Hannah Slater, Julie Gutman, Kassoum Kayentao, John E. Williams, Sheick O. Coulibaly, Carole Khairallah, Steve Taylor, Steven R. Meshnick, Jenny Hill, Victor Mwapasa, Linda Kalilani-Phiri, Kalifa Bojang, Simon Kariuki, Harry Tagbor, Jamie T. Griffin, Mwayi Madanitsa, Azra C. H. Ghani, Meghna Desai and Feiko O. ter Kuile
Additional contact information
Patrick G. T. Walker: Imperial College London
Matt Cairns: London School of Hygiene and Tropical Medicine
Hannah Slater: Imperial College London
Julie Gutman: Centers for Disease Control and Prevention
Kassoum Kayentao: University of Sciences, Techniques, and Technologies of Bamako
John E. Williams: Dodowa Health Research Centre
Sheick O. Coulibaly: University of Ouagadougou
Carole Khairallah: Liverpool School of Tropical Medicine
Steve Taylor: Duke University
Steven R. Meshnick: University of North Carolina
Jenny Hill: University of Ouagadougou
Victor Mwapasa: University of Malawi
Linda Kalilani-Phiri: Duke University
Kalifa Bojang: London School of Hygiene and Tropical Medicine
Simon Kariuki: Kenya Medical Research Institute/Centre for Global Health Research
Harry Tagbor: University of Health and Allied Sciences
Jamie T. Griffin: Queen Mary University of London
Mwayi Madanitsa: University of Malawi
Azra C. H. Ghani: Imperial College London
Meghna Desai: Centers for Disease Control and Prevention
Feiko O. ter Kuile: University of Ouagadougou

Nature Communications, 2020, vol. 11, issue 1, 1-12

Abstract: Abstract Plasmodium falciparum in pregnancy is a major cause of adverse pregnancy outcomes. We combine performance estimates of standard rapid diagnostic tests (RDT) from trials of intermittent screening and treatment in pregnancy (ISTp) with modelling to assess whether screening at antenatal visits improves upon current intermittent preventative therapy with sulphadoxine-pyrimethamine (IPTp-SP). We estimate that RDTs in primigravidae at first antenatal visit are substantially more sensitive than in non-pregnant adults (OR = 17.2, 95% Cr.I. 13.8-21.6), and that sensitivity declines in subsequent visits and with gravidity, likely driven by declining susceptibility to placental infection. Monthly ISTp with standard RDTs, even with highly effective drugs, is not superior to monthly IPTp-SP. However, a hybrid strategy, recently adopted in Tanzania, combining testing and treatment at first visit with IPTp-SP may offer benefit, especially in areas with high-grade SP resistance. Screening and treatment in the first trimester, when IPTp-SP is contraindicated, could substantially improve pregnancy outcomes.

Date: 2020
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DOI: 10.1038/s41467-020-17528-3

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