Efficiency of a Malaria Reactive Test-And-Treat Program in Southern Zambia: A Prospective, Observational Study
To improve malaria surveillance and achieve elimination, the Zambian National Malaria Elimination Program implemented a reactive test-and-treat program in Southern Province in 2013 in which individuals with rapid diagnostic test (RDT)–confirmed malaria are followed-up at their home within 1 week of diagnosis. Individuals present at the index case household and those residing within 140 m of the index case are tested with an RDT and treated with artemether–lumefantrine if positive. This study evaluated the efficiency of this reactive test-and-treat strategy by characterizing infected individuals missed by the RDT and the current screening radius. The radius was expanded to 250 m, and a quantitative polymerase chain reaction (qPCR) test was performed on dried blood spot specimens. From January 2015 through March 2016, 145 index cases were identified at health centers and health posts. A total of 3,333 individuals residing in 525 households were screened. Excluding index cases, the parasite prevalence was 1.1% by RDT (33 positives of 3,016 participants) and 2.4% by qPCR (73 positives of 3,016 participants). Of the qPCR-positive cases, 62% of 73 individuals tested negative by RDT. Approximately half of the infected individuals resided within the index case household (58% of RDT-positive individuals and 48% of qPCR-positive individuals). The low sensitivity of the RDT and the high proportion of secondary cases within the index case household decreased the efficiency of this reactive test-and-treat strategy. Reactive focal drug administration in index case households would be a more efficient approach to treating infected individuals associated with a symptomatic case.
Molly, D-F; Hamapumbu, H.; Lubinda, J.; Musonda, M.; Katowa, B.; Searle, K. M.; Kobayashi, T.; Shields, T. M.; Stevenson, J.; Thuma, Philip; and Moss, W. J., "Efficiency of a Malaria Reactive Test-And-Treat Program in Southern Zambia: A Prospective, Observational Study" (2018). Biology Educator Scholarship. 163.
Molly, D.-F., et al. (2018). Efficiency of a malaria reactive test-and-treat program in Southern Zambia: A prospective, observational study. American Journal of Tropical Medicine and Hygiene 98(5) 1382-1388.
© 2018 American Journal of Tropical Medicine and Hygiene. Original published version available at https://doi.org/10.4269/ajtmh.17-0865.Deutsch-Feldman, M., Hamapumbu, H., Lubinda, J., Musonda, M., Katowa, B., Searle, K. M., Kobayashi, T., Shields, T. M., Stevenson, J. C., Thuma, P. E., Moss, W. J., & for the Southern Africa International Centers of Excellence for Malaria Research. (2018). Efficiency of a malaria reactive test-and-treat program in southern zambia: A prospective, observational study. The American Journal of Tropical Medicine and Hygiene, 98(5), 1382–1388. https://doi.org/10.4269/ajtmh.17-0865