Malaria Treatment & Prevention

In my experience, mRDTs are often implemented at the community level without a good quality assurance plan in place. Even at the national/sub-national level there is a great deal of confusion among health workers regarding national guidelines (where should RDTs be used, when, how to manage negative results, etc.). MOHs have gone a long way to augment diagnostic capacity where microscopy services are not available with RDTs - but introduction to the community level should be well planned and include at a minimum good training materials that have been piloted (Zambia is a good example), budget to support routine supervision, a plan for dealing with suspicious lots, adequate storage, timing devices, reporting, and safety to name a few). I have not heard anything about the new HIV home test in regards to CHWs as of yet. I just hope that with any new diagnostic a good plan is in place and working well at the sub-national level before they are placed in the hands of the CHW.

I absolutely agree!

I totally agree with the comment that quality assurance is critical as well as referral system for RDT negative cases to ensure that they are evaluated for other causes if illness.

Awash

That's true Nicole. The issue of elaborate Quality Assurance (QA) programs with mRDTs at national level is often ignored (unlike with HIV RDTs). From my experience QA aspects like periodic proficiency testing of the RDTs with "blind samples" by end users which is done with HIV RDTs is equally important with mRDTs to keep testing processes inn check. Blind samples are provided by National Reference Labs. I think the fact that there are no QA processes in place is one of the reasons why doctors sometimes prefer that traditional microscopy test with a lower sensitivity to the RDT. End users like CHW and nurses need to be trained on how to use these tests. They are simple but if QA issues like the ones Nicole has mentioned are ignored, a significant number of results could be inaccurate or invalid.

The Positive Control Wells (PCWs) that will be provided with the malaria RDTs will address the issue of quality assurance at the health worker's level. WHO/FIND have been on top of this and hopefully, these PCWs will be available to ensure the quality of malaria RDTs even at the lowest health facility levels.

Wellington Oyibo

Thank you!! The rapid strep tests in the US are designed this way. If people are interested , wwww.wmpeds.com go to patient education parent video and look at sore throat. Curious any countries where smart phones are becoming cheap and more available for You Tube videos. In US though not FDA approved people can order rapid strep test online on Amazon.

I completely agree that periodic proficiency testing of RDT end users is
important, especially where more than one brand of RDTs are available for
use or a new brand of RDT is introduced into the health care system to
replace another brand that primary health care workers were used to.
Periodic proficiency testing of RDT end users should be one of the routine
activities of malaria programs.

The positive control wells that Professor Wellington describes would go a long way to ensure good quality control for mRDTs. In the meantime - similar efforts are being made - see recent manuscript attached "Dried Plasmodium falciparum-infected samples as positive controls for malaria rapid diagnostic tests" - M. Aidoo et al.