Assessing the impact of next-generation rapid diagnostic tests on Plasmodium falciparum malaria elimination strategies

Hannah C. Slater (), Amanda Ross, André Lin Ouédraogo, Lisa J. White, Chea Nguon, Patrick G.T. Walker, Pengby Ngor, Ricardo Aguas, Sheetal P. Silal, Arjen M. Dondorp, Paul La Barre, Robert Burton, Robert W. Sauerwein, Chris Drakeley, Thomas A. Smith, Teun Bousema and Azra C. Ghani
Additional contact information
Hannah C. Slater: MRC Centre for Outbreak Analysis and Modelling, Faculty of Medicine, Imperial College London
Amanda Ross: Swiss Tropical and Public Health Institute
André Lin Ouédraogo: Institute for Disease Modelling
Lisa J. White: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University
Chea Nguon: National Malaria Center, Ministry of Health
Patrick G.T. Walker: MRC Centre for Outbreak Analysis and Modelling, Faculty of Medicine, Imperial College London
Pengby Ngor: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University
Ricardo Aguas: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University
Sheetal P. Silal: University of Cape Town
Arjen M. Dondorp: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University
Paul La Barre: PATH
Robert Burton: PATH
Robert W. Sauerwein: Radboud University Medical Center
Chris Drakeley: London School of Hygiene & Tropical Medicine
Thomas A. Smith: Swiss Tropical and Public Health Institute
Teun Bousema: Radboud University Medical Center
Azra C. Ghani: MRC Centre for Outbreak Analysis and Modelling, Faculty of Medicine, Imperial College London

Nature, 2015, vol. 528, issue 7580, S94-S101

Abstract: Abstract Mass-screen-and-treat and targeted mass-drug-administration strategies are being considered as a means to interrupt transmission of Plasmodium falciparum malaria. However, the effectiveness of such strategies will depend on the extent to which current and future diagnostics are able to detect those individuals who are infectious to mosquitoes. We estimate the relationship between parasite density and onward infectivity using sensitive quantitative parasite diagnostics and mosquito feeding assays from Burkina Faso. We find that a diagnostic with a lower detection limit of 200 parasites per microlitre would detect 55% of the infectious reservoir (the combined infectivity to mosquitoes of the whole population weighted by how often each individual is bitten) whereas a test with a limit of 20 parasites per microlitre would detect 83% and 2 parasites per microlitre would detect 95% of the infectious reservoir. Using mathematical models, we show that increasing the diagnostic sensitivity from 200 parasites per microlitre (equivalent to microscopy or current rapid diagnostic tests) to 2 parasites per microlitre would increase the number of regions where transmission could be interrupted with a mass-screen-and-treat programme from an entomological inoculation rate below 1 to one of up to 4. The higher sensitivity diagnostic could reduce the number of treatment rounds required to interrupt transmission in areas of lower prevalence. We predict that mass-screen-and-treat with a highly sensitive diagnostic is less effective than mass drug administration owing to the prophylactic protection provided to uninfected individuals by the latter approach. In low-transmission settings such as those in Southeast Asia, we find that a diagnostic tool with a sensitivity of 20 parasites per microlitre may be sufficient for targeted mass drug administration because this diagnostic is predicted to identify a similar village population prevalence compared with that currently detected using polymerase chain reaction if treatment levels are high and screening is conducted during the dry season. Along with other factors, such as coverage, choice of drug, timing of the intervention, importation of infections, and seasonality, the sensitivity of the diagnostic can play a part in increasing the chance of interrupting transmission. This article has not been written or reviewed by Nature editors. Nature accepts no responsibility for the accuracy of the information provided.

Date: 2015
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DOI: 10.1038/nature16040

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