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Clin Infect Dis. 2019 May 16. pii: ciz403. doi: 10.1093/cid/ciz403. [Epub ahead of print]

Active case-finding for malaria: A three-year national evaluation of optimal approaches to detect infections and hotspots through reactive case detection in the low transmission setting of Eswatini.

Author information

1
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, USA.
2
Malaria Elimination Initiative, Global Health Group, University of California, San Francisco (UCSF), USA.
3
Department of Pediatrics, UCSF, USA.
4
Clinton Health Access Initiative, Eswatini Office, Mbabane, Eswatini.
5
Division of Prevention Science, Department of Medicine, UCSF, USA.
6
Eswatini National Malaria Programme, Manzini, Eswatini.
7
Eswatini National Reference Laboratory, Mbabane, Eswatini.
8
Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, UCSF, USA.

Abstract

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 three-year prospective national evaluation of RACD in Eswatini, a malaria elimination setting. Loop-mediated isothermal amplification (LAMP) was compared to traditional rapid diagnostic test (RDT) for the improved detection of infections, and 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 meters of index cases were tested. Compared to RDT, LAMP provided a 3- 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-meter 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.

KEYWORDS:

Eswatini; efficiency; loop-mediated isothermal amplification; malaria elimination; reactive case detection

PMID:
31095677
DOI:
10.1093/cid/ciz403

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