An Update on Malaria Rapid Diagnostic Tests

Modern advances in malaria rapid diagnostic test (RDT) technology have increased demand for low-cost, easy-to-use assays in areas endemic for malaria. Substantial developments in diagnostic sensitivity and specificity, improvements in non-falciparum RDTs, and novel biotechnological innovations are gradually aligning the performance of RDTs with reference-level diagnostics including PCR and expert microscopy gold standards.

Trends have emerged in recent malaria RDT literature: (1) improvements in the sensitivity and specificity of RDTs for Plasmodium falciparum diagnosis, making them comparable to expert microscopic examination; (2) reduced false-positive and false-negative reactions with novel antibody development; (3) improved sensitivity and specificity capabilities of Plasmodium vivax-specific RDTs; (4) developing RDTs for co-endemic mixed infection differentiation; (5) significant improvements of RDTs for Plasmodium knowlesi; (6) a global push towards assessing and confronting the growing concerns of widespread pfhrp2 gene deletions; and (7) original innovation in loop-mediated isothermal amplification (LAMP) biotechnological RDT-like platforms that demonstrate promising performance characteristics for P. falciparum, P. vivax, and P. knowlesi infections. The past 5 years have been characterized by increasing demand for malaria RDTs, translating into meaningful improvements in performance and novel biotechnological innovation. Future work should facilitate the development of improved RDT platforms for Plasmodium ovale, P. knowlesi, and Plasmodium malariae, and surmount the issue of pfhrp2 gene deletions, while maintaining comparable performance to both PCR and expert microscopy reference standards.