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Feasibility of self-testing for acute malaria using rapid diagnostic tests in three peri-urban sub-Saharan African
Amanda Brumwell1, Meagan Bemer2, Amber Lauff2
1Department of Global Health, University of Washington, Seattle, USA. brumwell@uw.edu.
Insights
Malaria rapid diagnostic tests (RDTs) are feasible for self-testing in sub-Saharan Africa. High acceptability and correct interpretation by users suggest RDT self-testing can improve malaria diagnosis in high-burden areas.
Area of Science:
- Tropical Medicine
- Public Health
- Diagnostics
Background:
- Malaria remains a critical cause of mortality in children under five in sub-Saharan Africa (SSA).
- World Health Organization (WHO)-approved malaria rapid diagnostic tests (RDTs) offer a cost-effective diagnostic alternative.
- RDTs hold potential for improving timely malaria diagnosis through self-testing.
Purpose of the Study:
- To evaluate the feasibility and acceptability of malaria RDT self-testing in SSA.
- To assess user perception of RDT usability, including specimen collection, test operation, and result interpretation.
Main Methods:
- A feasibility study involving 100 households per site in Kenya, South Africa, and Zambia.
- Surveys were conducted with participants to assess perceived usability, acceptability, and preferences for RDT self-testing.
- RDT interpretation accuracy was compared between participants and trained study personnel.
Main Results:
- Malaria prevalence varied across sites: 11.5% in Kenya, 0% in South Africa, and 1.8% in Zambia.
- Participants demonstrated high accuracy in RDT interpretation (100% sensitivity, 99.7% specificity compared to study team).
- Over 96% of participants found RDTs easy to use, with high confidence in self-interpretation and strong willingness for future self-testing.
Conclusions:
- Malaria RDT self-testing is highly acceptable and feasible in SSA settings.
- The study supports the potential of RDT self-testing to enhance malaria diagnosis and care access in high-burden regions.
Background:
Malaria is a significant cause of under-five child mortality in sub-Saharan Africa (SSA). The World Health Organization (WHO)-approved rapid diagnostic tests (RDT) for malaria offer a resource-efficient alternative to gold-standard diagnostic methods and may improve timely access to care through self-testing.
Methods:
The feasibility of use of RDT for self-testing was evaluated in 100 households each in Migori County, Kenya; KwaZulu-Natal Province, South Africa; and Copperbelt Province, Zambia. Surveys assessed perceived usability, acceptability, and preferences for RDTs among consenting participants.
Results:
Among 225 participants in Kenya, 80 in South Africa, and 163 in Zambia, 25 (11.5%), 0 (0.0%), and 3 (1.8%) tested positive for malaria, respectively. In Kenya and Zambia, 89% of participants reported previous malaria diagnoses. Participants across all three sites interpreted the RDT with 100% sensitivity and 99.7% specificity compared to RDT interpretation performed by a trained study team member, with only one individual interpreting their test incorrectly. Over 96% of participants across all three sites felt the RDT would be easy to use for specimen collection, test operation, and result interpretation, and 160 (100%) Kenyan participants, 74 (96.1%) South African participants, and 157 (99.4%) Zambian participants felt confident that they had interpreted their own test correctly. Participants' perceived comfort for future self-testing with an RDT was high in Kenya (92%) and Zambia (86%), and moderate in South Africa (66%).
Conclusions:
These findings indicate that RDT self-testing is highly acceptable and feasible in SSA settings with a high malaria burden.
