Performance of Two Malaria Rapid Diagnostic Tests in Febrile Adult Patients with and without Human Immunodeficiency Virus-1 Infection in Blantyre, Malawi

The performance of two histidine-rich protein type-2–based malaria rapid diagnostic tests (mRDTs) was examined in a rural area with a high prevalence of malaria and human immunodeficiency virus type-1 (HIV-1) infection in 113 and 445 febrile patients ≥ 15 years of age with and without HIV-1 infection, respectively. Patients were tested for HIV-1 infection by using a standard assay and for Plasmodium falciparum by using two mRDTs and microscopy. When microscopy was used as the gold standard, both mRDTs performed similarly in patients with and without HIV-1 infection: Bioline SD Malaria Antigen P.f, sensitivity 94.4% (95% confidence interval [CI]: 81.3–99.3%) versus 97.1% (95% CI:92.8–99.2%) and specificity 50.6% (95% CI: 39.0–62.2%) versus 47.2% (95% CI: 41.4–53.1%); and ICT diagnostics Malaria Pf, sensitivity 94.4% (95% CI: 81.3–99.3%) versus 97.1% (95% CI: 92.8–99.2%) and specificity 50.6% (95% CI:39.0–62.2%) versus 50.3% (95% CI: 44.4–56.1%). Infection with HIV-1 does not appear to affect the performance of these histidine-rich protein type-2 (HRP-2)-based mRDTs.