TY - JOUR
T1 - Active case finding for malaria
T2 - A 3-year national evaluation of optimal approaches to detect infections and hotspots through reactive case detection in the low-transmission setting of eswatini
AU - Hsiang, Michelle S.
AU - Ntshalintshali, Nyasatu
AU - Kang Dufour, Mi Suk
AU - Dlamini, Nomcebo
AU - Nhlabathi, Nomcebo
AU - Vilakati, Sibonakaliso
AU - Malambe, Calsile
AU - Zulu, Zulisile
AU - Maphalala, Gugu
AU - Novotny, Joseph
AU - Murphy, Maxwell
AU - Schwartz, Alanna
AU - Sturrock, Hugh
AU - Gosling, Roly
AU - Dorsey, Grant
AU - Kunene, Simon
AU - Greenhouse, Bryan
N1 - Publisher Copyright:
© 2019 The Author(s). Published by Oxford University Press for the Infectious Diseases Society of America.
PY - 2020/3/17
Y1 - 2020/3/17
N2 - 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.
AB - 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.
KW - Eswatini
KW - efficiency
KW - loop-mediated isothermal amplification
KW - malaria elimination
KW - reactive case detection
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U2 - 10.1093/cid/ciz403
DO - 10.1093/cid/ciz403
M3 - Article
C2 - 31095677
AN - SCOPUS:85082098590
SN - 1058-4838
VL - 70
SP - 1316
EP - 1325
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 7
ER -