Active Case Finding for Malaria: A 3-Year National Evaluation of Optimal Approaches to Detect Infections and Hotspots Through Reactive Case Detection in the Low-transmission Setting of Eswatini
| Autor: | Simon Kunene, Alanna Schwartz, Hugh J. W. Sturrock, Mi-Suk Kang Dufour, Maxwell Murphy, Roly Gosling, Nomcebo Dlamini, Joseph Novotny, Gugu Maphalala, Bryan Greenhouse, Nyasatu Ntshalintshali, Michelle S. Hsiang, Sibonakaliso Vilakati, Calsile Malambe, Zulisile Zulu, Grant Dorsey, Nomcebo Nhlabathi |
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| Rok vydání: | 2019 |
| Předmět: |
Microbiology (medical)
Future studies Target population Low transmission reactive case detection Environmental health Malaria elimination Humans Medicine Prospective Studies Articles and Commentaries malaria elimination Index case Case detection business.industry medicine.disease Malaria AcademicSubjects/MED00290 Infectious Diseases Molecular Diagnostic Techniques efficiency Case finding business Eswatini Nucleic Acid Amplification Techniques loop-mediated isothermal amplification |
| Zdroj: | Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America |
| ISSN: | 1537-6591 1058-4838 |
| DOI: | 10.1093/cid/ciz403 |
| Popis: | Background Reactive case detection (RACD) is a widely practiced malaria elimination intervention whereby close contacts of index cases receive malaria testing to inform treatment and other interventions. However, the optimal diagnostic and operational approaches for this resource-intensive strategy are not clear. Methods We conducted a 3-year prospective national evaluation of RACD in Eswatini, a malaria elimination setting. Loop-mediated isothermal amplification (LAMP) was compared to traditional rapid diagnostic testing (RDT) for the improved detection of infections and for hotspots (RACD events yielding ≥1 additional infection). The potential for index case–, RACD-, and individual-level factors to improve efficiencies was also evaluated. Results Among 377 RACD events, 10 890 participants residing within 500 m of index cases were tested. Compared to RDT, LAMP provided a 3-fold and 2.3-fold higher yield to detect infections (1.7% vs 0.6%) and hotspots (29.7% vs 12.7%), respectively. Hotspot detection improved with ≥80% target population coverage and response times within 7 days. Proximity to the index case was associated with a dose-dependent increased infection risk (up to 4-fold). Individual-, index case–, and other RACD-level factors were considered but the simple approach of restricting RACD to a 200-m radius maximized yield and efficiency. Conclusions We present the first large-scale national evaluation of optimal RACD approaches from a malaria elimination setting. To inform delivery of antimalarial drugs or other interventions, RACD, when conducted, should utilize more sensitive diagnostics and clear context-specific operational parameters. Future studies of RACD’s impact on transmission may still be needed. Optimal approaches to find malaria infections and hotspots in reactive case detection are not clear. Here, molecular testing compared to standard rapid diagnostic testing and operational factors (≥80% coverage, response ≤7 days, and 200-m screening radius) maximized efficiency and yield. |
| Databáze: | OpenAIRE |
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