Point-of-care dengue detection in Indonesia: Locally assembled NS1 and IgM combination rapid diagnostic tests (RDTs)...

Dengue infection remains a major public health concern in Indonesia. Rapid and valid dengue virus (DENV) diagnosis is critical to prompt care and intervention. Reverse transcription quantitative polymerase chain reaction (RT-qPCR), as the gold standard, is challenging to implement in fast-paced settings with limited resources. Therefore, rapid diagnostic tests (RDTs) offer a practical and simpler alternative with differing accuracy. This study aims to compare RDTs' performance with RT-qPCR using specimens of dengue-suspected patients from two hospitals in North Jakarta. A total of 111 archived paired whole blood and plasma specimens were analyzed using the Dengue non-structural protein 1 (NS1) antigen and Dengue Combo NS1 Immunoglobulin (Ig)G/IgM RDT kits, respectively. Diagnostic accuracy and validity parameters were calculated to assess RDT kits' interpretation. The results were further analyzed using the clinical symptoms and blood profiles of patients. Among all the tests, the combination of Combo NS1/IgM results provides the best diagnostic approach to reflect the acute and recent dengue infections in clinical settings, as both combinations showed better sensitivity (79.2%), specificity (79.3%), positive predictive value/PPV (77.8%), and negative predictive value/NPV (80.7%) compared to RT-qPCR. Moreover, Combo NS1/IgM displayed the finest correlation with clinical manifestation according to the World Health Organization (WHO) (OR=12.67, 95% CI=1.57-101.94), though advanced exploration is needed. Meanwhile, IgG showed the lowest performance among all parameters. Dengue RDTs, especially NS1/IgM assays, demonstrated complementary diagnostic value with notable associations to RT-qPCR, clinical features, and hematological parameters. These findings support their integration into routine dengue management while emphasizing its further optimization.