Evaluating the implementation of rapid diagnostic tests in a malaria elimination setting

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Diagnostic Test Implementation

Background:

• Limited evidence exists on the effectiveness of malaria rapid diagnostic tests (RDTs) in malaria elimination settings.
• This study addresses the gap by examining RDT implementation and its impact on imported malaria case diagnosis in Jiangsu Province, China.

Purpose of the Study:

• To evaluate the impact of a scaled-up RDT implementation package on malaria diagnosis in Jiangsu Province.
• To assess the effect of RDTs on delayed diagnosis, confirmed diagnoses at township-level institutions, and severe malaria cases.

Main Methods:

• A pretest-posttest control group design was employed, with interventions implemented in 4 cities and 9 cities serving as controls from January 2017 to January 2018.
• An intervention package included RDT supply, training, monitoring, and advocacy.
• Difference-in-Difference analysis with linear probability regression was used to assess the impact on delayed diagnosis, confirmed diagnosis, and severe malaria.

Main Results:

• The intervention package led to a statistically significant 10.8% reduction in delayed malaria diagnoses (P=0.021).
• No significant increase was observed in confirmed malaria diagnoses at township-level institutions (P=0.185).
• The intervention did not significantly reduce the number of severe malaria cases (P=0.592).

Conclusions:

• A comprehensive RDT implementation package is effective in reducing delayed malaria diagnoses.
• The findings suggest that scaled-up RDT use can improve access to care for malaria patients, particularly in malaria elimination settings.
• Further research may be needed to optimize RDT strategies for reducing severe malaria outcomes.