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Impact of malaria diagnostic choice on monitoring of Plasmodium falciparum prevalence estimates in the Democratic Republic of the Congo and relevance to control programs in high-burden countries

Malaria programs rely upon a variety of diagnostic assays, including rapid diagnostic tests (RDTs), microscopy, polymerase chain reaction (PCR), and bead-based immunoassays (BBA), to monitor malaria prevalence and support control and elimination efforts. Data comparing these assays are limited, espe...

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Autores principales: Diallo, Alpha Oumar, Banek, Kristin, Kashamuka, Melchior Mwandagalirwa, Bala, Joseph Alexandre Mavungu, Nkalani, Marthe, Kihuma, Georges, Nseka, Tommy Mambulu, Atibu, Joseph Losoma, Mahilu, Georges Emo, McCormick, Lauren, White, Samuel J., Sendor, Rachel, Sinai, Cyrus, Keeler, Corinna, Herman, Camelia, Emch, Michael, Sompwe, Eric, Thwai, Kyaw Lay, Dinglasan, Rhoel R., Rogier, Eric, Juliano, Jonathan J., Tshefu, Antoinette Kitoto, Parr, Jonathan B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10370698/
https://www.ncbi.nlm.nih.gov/pubmed/37494361
http://dx.doi.org/10.1371/journal.pgph.0001375
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author Diallo, Alpha Oumar
Banek, Kristin
Kashamuka, Melchior Mwandagalirwa
Bala, Joseph Alexandre Mavungu
Nkalani, Marthe
Kihuma, Georges
Nseka, Tommy Mambulu
Atibu, Joseph Losoma
Mahilu, Georges Emo
McCormick, Lauren
White, Samuel J.
Sendor, Rachel
Sinai, Cyrus
Keeler, Corinna
Herman, Camelia
Emch, Michael
Sompwe, Eric
Thwai, Kyaw Lay
Dinglasan, Rhoel R.
Rogier, Eric
Juliano, Jonathan J.
Tshefu, Antoinette Kitoto
Parr, Jonathan B.
author_facet Diallo, Alpha Oumar
Banek, Kristin
Kashamuka, Melchior Mwandagalirwa
Bala, Joseph Alexandre Mavungu
Nkalani, Marthe
Kihuma, Georges
Nseka, Tommy Mambulu
Atibu, Joseph Losoma
Mahilu, Georges Emo
McCormick, Lauren
White, Samuel J.
Sendor, Rachel
Sinai, Cyrus
Keeler, Corinna
Herman, Camelia
Emch, Michael
Sompwe, Eric
Thwai, Kyaw Lay
Dinglasan, Rhoel R.
Rogier, Eric
Juliano, Jonathan J.
Tshefu, Antoinette Kitoto
Parr, Jonathan B.
author_sort Diallo, Alpha Oumar
collection PubMed
description Malaria programs rely upon a variety of diagnostic assays, including rapid diagnostic tests (RDTs), microscopy, polymerase chain reaction (PCR), and bead-based immunoassays (BBA), to monitor malaria prevalence and support control and elimination efforts. Data comparing these assays are limited, especially from high-burden countries like the Democratic Republic of the Congo (DRC). Using cross-sectional and routine data, we compared diagnostic performance and Plasmodium falciparum prevalence estimates across health areas of varying transmission intensity to illustrate the relevance of assay performance to malaria control programs. Data and samples were collected between March–June 2018 during a cross-sectional household survey across three health areas with low, moderate, and high transmission intensities within Kinshasa Province, DRC. Samples from 1,431 participants were evaluated using RDT, microscopy, PCR, and BBA. P. falciparum parasite prevalence varied between diagnostic methods across all health areas, with the highest prevalence estimates observed in Bu (57.4–72.4% across assays), followed by Kimpoko (32.6–53.2%), and Voix du Peuple (3.1–8.4%). Using latent class analysis to compare these diagnostic methods against an “alloyed gold standard,” the most sensitive diagnostic method was BBA in Bu (high prevalence) and Voix du Peuple (low prevalence), while PCR diagnosis was most sensitive in Kimpoko (moderate prevalence). RDTs were consistently the most specific diagnostic method in all health areas. Among 9.0 million people residing in Kinshasa Province in 2018, the estimated P. falciparum prevalence by microscopy, PCR, and BBA were nearly double that of RDT. Comparison of malaria RDT, microscopy, PCR, and BBA results confirmed differences in sensitivity and specificity that varied by endemicity, with PCR and BBA performing best for detecting any P. falciparum infection. Prevalence estimates varied widely depending on assay type for parasite detection. Inherent differences in assay performance should be carefully considered when using community survey and surveillance data to guide policy decisions.
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spelling pubmed-103706982023-07-27 Impact of malaria diagnostic choice on monitoring of Plasmodium falciparum prevalence estimates in the Democratic Republic of the Congo and relevance to control programs in high-burden countries Diallo, Alpha Oumar Banek, Kristin Kashamuka, Melchior Mwandagalirwa Bala, Joseph Alexandre Mavungu Nkalani, Marthe Kihuma, Georges Nseka, Tommy Mambulu Atibu, Joseph Losoma Mahilu, Georges Emo McCormick, Lauren White, Samuel J. Sendor, Rachel Sinai, Cyrus Keeler, Corinna Herman, Camelia Emch, Michael Sompwe, Eric Thwai, Kyaw Lay Dinglasan, Rhoel R. Rogier, Eric Juliano, Jonathan J. Tshefu, Antoinette Kitoto Parr, Jonathan B. PLOS Glob Public Health Research Article Malaria programs rely upon a variety of diagnostic assays, including rapid diagnostic tests (RDTs), microscopy, polymerase chain reaction (PCR), and bead-based immunoassays (BBA), to monitor malaria prevalence and support control and elimination efforts. Data comparing these assays are limited, especially from high-burden countries like the Democratic Republic of the Congo (DRC). Using cross-sectional and routine data, we compared diagnostic performance and Plasmodium falciparum prevalence estimates across health areas of varying transmission intensity to illustrate the relevance of assay performance to malaria control programs. Data and samples were collected between March–June 2018 during a cross-sectional household survey across three health areas with low, moderate, and high transmission intensities within Kinshasa Province, DRC. Samples from 1,431 participants were evaluated using RDT, microscopy, PCR, and BBA. P. falciparum parasite prevalence varied between diagnostic methods across all health areas, with the highest prevalence estimates observed in Bu (57.4–72.4% across assays), followed by Kimpoko (32.6–53.2%), and Voix du Peuple (3.1–8.4%). Using latent class analysis to compare these diagnostic methods against an “alloyed gold standard,” the most sensitive diagnostic method was BBA in Bu (high prevalence) and Voix du Peuple (low prevalence), while PCR diagnosis was most sensitive in Kimpoko (moderate prevalence). RDTs were consistently the most specific diagnostic method in all health areas. Among 9.0 million people residing in Kinshasa Province in 2018, the estimated P. falciparum prevalence by microscopy, PCR, and BBA were nearly double that of RDT. Comparison of malaria RDT, microscopy, PCR, and BBA results confirmed differences in sensitivity and specificity that varied by endemicity, with PCR and BBA performing best for detecting any P. falciparum infection. Prevalence estimates varied widely depending on assay type for parasite detection. Inherent differences in assay performance should be carefully considered when using community survey and surveillance data to guide policy decisions. Public Library of Science 2023-07-26 /pmc/articles/PMC10370698/ /pubmed/37494361 http://dx.doi.org/10.1371/journal.pgph.0001375 Text en https://creativecommons.org/publicdomain/zero/1.0/This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication.
spellingShingle Research Article
Diallo, Alpha Oumar
Banek, Kristin
Kashamuka, Melchior Mwandagalirwa
Bala, Joseph Alexandre Mavungu
Nkalani, Marthe
Kihuma, Georges
Nseka, Tommy Mambulu
Atibu, Joseph Losoma
Mahilu, Georges Emo
McCormick, Lauren
White, Samuel J.
Sendor, Rachel
Sinai, Cyrus
Keeler, Corinna
Herman, Camelia
Emch, Michael
Sompwe, Eric
Thwai, Kyaw Lay
Dinglasan, Rhoel R.
Rogier, Eric
Juliano, Jonathan J.
Tshefu, Antoinette Kitoto
Parr, Jonathan B.
Impact of malaria diagnostic choice on monitoring of Plasmodium falciparum prevalence estimates in the Democratic Republic of the Congo and relevance to control programs in high-burden countries
title Impact of malaria diagnostic choice on monitoring of Plasmodium falciparum prevalence estimates in the Democratic Republic of the Congo and relevance to control programs in high-burden countries
title_full Impact of malaria diagnostic choice on monitoring of Plasmodium falciparum prevalence estimates in the Democratic Republic of the Congo and relevance to control programs in high-burden countries
title_fullStr Impact of malaria diagnostic choice on monitoring of Plasmodium falciparum prevalence estimates in the Democratic Republic of the Congo and relevance to control programs in high-burden countries
title_full_unstemmed Impact of malaria diagnostic choice on monitoring of Plasmodium falciparum prevalence estimates in the Democratic Republic of the Congo and relevance to control programs in high-burden countries
title_short Impact of malaria diagnostic choice on monitoring of Plasmodium falciparum prevalence estimates in the Democratic Republic of the Congo and relevance to control programs in high-burden countries
title_sort impact of malaria diagnostic choice on monitoring of plasmodium falciparum prevalence estimates in the democratic republic of the congo and relevance to control programs in high-burden countries
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10370698/
https://www.ncbi.nlm.nih.gov/pubmed/37494361
http://dx.doi.org/10.1371/journal.pgph.0001375
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