Efficiency of a malaria reactive test-and-treat program in Southern Zambia: A prospective, observational study

for the Southern Africa International Centers of Excellence for Malaria Research

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1382-1388
Number of pages7
JournalAmerican Journal of Tropical Medicine and Hygiene
Volume98
Issue number5
DOIs
StatePublished - Jan 1 2018

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Zambia
Routine Diagnostic Tests
Malaria
Observational Studies
Prospective Studies
Polymerase Chain Reaction
Health
Parasites
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Parasitology
  • Infectious Diseases
  • Virology

Cite this

Efficiency of a malaria reactive test-and-treat program in Southern Zambia : A prospective, observational study. / for the Southern Africa International Centers of Excellence for Malaria Research.

In: American Journal of Tropical Medicine and Hygiene, Vol. 98, No. 5, 01.01.2018, p. 1382-1388.

Research output: Contribution to journalArticle

for the Southern Africa International Centers of Excellence for Malaria Research. / Efficiency of a malaria reactive test-and-treat program in Southern Zambia : A prospective, observational study. In: American Journal of Tropical Medicine and Hygiene. 2018 ; Vol. 98, No. 5. pp. 1382-1388.
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