Varying Malaria Rapid Diagnostic Test Accuracy by Regional Transmission Level and Demographics in Tanzania

Malaria remains a significant global health burden, with approximately 263 million cases across 83 countries. It's essential for malarial infection control to quickly and accurately detect cases. Given the widespread use of malaria rapid diagnostic testing (mRDTs) for case management and surveillance, it's essential to understand test reliability. Clarifying how mRDT results differ from qPCR results, and the nature of additional variance by test manufacturer, will be useful for reducing measurement bias. In comparing 3 national standard mRDTs and a research mRDT with qPCR results from a 2021 cross-sectional study in Tanzania, differences were found by age, gender and regional malaria transmission rate. The research test overall underperformed, with poor sensitivity across transmission strata. In comparing the research mRDT to standard mRDTs, odds ratios suggested transmission intensity may affect mRDT agreement and diagnostic performance. These results offer pertinent information on test accuracy and decrease outcome misclassification for malaria prevalence.