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Table 2 Analysis of test type for a combination HS-RDT to support ACD

From: International survey to identify diagnostic needs to support malaria elimination: guiding the development of combination highly sensitive rapid diagnostic tests

Test type Interpretation and treatment Advantages Disadvantages Comments
Pan/Pf/Pv Pan(+)/Pf(+)/Pv(+) → ACT + PQ
Pan(+)/Pf(+)/Pv() → ACT
Pan(+)/Pf()/Pv(+) → CQ + PQ
Pan(+)/Pf()/Pv() → CQ
Detects all species
Differentiates Pf
Allows targeted Pv radical cure
Does not target Po radical cure Helpful for surveillance in drug resistant areas because differentiates Pf
Difficult interpretation by end user
Technically challenging
Pan/Pf Pan(+)/Pf(+) → ACT
Pan(+)/Pf() → CQ(+PQ)
Detects all species
Differentiates Pf
Pan(+)/Pf(+) could be a mixed infection requiring PQ
Pan(+)/Pf() would not receive PQ if Pv not confirmed
Helpful for surveillance in drug resistant areas because differentiates Pf
29% of current RDT volume market
Common, familiar format
Pf/Pv Pf(+)/Pv(+) → ACT + PQ
Pf(+)/Pv() → ACT
Pf()/Pv(+) → CQ + PQ
Differentiates Pf
Allows targeted Pv radical cure
Does not detect Pm/Po/Pk
Does not target Po radical cure
Helpful for surveillance in drug resistant areas because differentiates Pf
6% of current RDT volume market
Pf/Pvom Pf(+)/Pvom(+) → ACT + PQ
Pf(+)/Pvom() → ACT
Pf()/Pvom(+) → CQ + PQ
Differentiates Pf
Allows targeted Pv and Po radical cure
Over-treatment of Pm with PQ
Does not detect Pk
Helpful for surveillance in drug resistant areas because differentiates Pf
Commercial product available
Pan/Pvo Pan(+)/Pvo(+) → ACT + PQ
Pan(+)/Pvo() → ACT
Detects all species
Allows targeted Pv and Po radical cure
Does not differentiate Pf Shift from CQ to ACT for non-falciparum
Limited surveillance data on species; speciation at reference lab required
Pan only Pan(+) → ACT + PQ Detects all species Over-treatment of Pf/Pm/Pk with PQ
Does not differentiate Pf
Shift from CQ to ACT for non-falciparum
Limited surveillance data on species; speciation at reference lab required
  1. This analysis assumes that all test lines have the same limit of detection required to detect sub-microscopic infections and that glucose-6-phosphate dehydrogenase (G6PD) deficiency testing is available and done when required
  2. HS-RDT (high sensitive rapid diagnostic test); ACD (Active Case Detection); Pan (all Plasmodium species); Pf (Plasmodium falciparum); Pv (P. vivax); Pvom (P. vivax, P. ovale, and P. malariae); Pvo (P. vivax and P. ovale); Pk (P. knowlesi); ACT (artemisinin-combination therapy); PQ (primaquine); CQ (chloroquine); NAATs (nucleic acid amplification techniques)