title: Accuracy of two malaria rapid diagnostic tests (RDTS) for initial diagnosis and treatment monitoring in a high transmission setting in Uganda.
abstract: Malaria rapid diagnostic tests (RDTs) may improve fever management in areas without microscopy. We compared the accuracy of histidine-rich protein 2 (HRP2) and Plasmodium lactate dehydrogenase (pLDH)-based RDTs, using expert microscopy as a gold standard, for initial diagnosis, treatment monitoring, and diagnosis of recurrent malaria in a cohort of children followed longitudinally in a high-transmission area in Uganda. For 305 initial fever episodes, sensitivity was 98% for HRP2 and 87% for pLDH, whereas specificity was 55% and 96%, respectively. The HRP2 gave 51% false-positive results on Day 28, whereas pLDH gave no false positives after Day 7. For 59 recurrent fever episodes during follow-up, sensitivity was 100% for HRP2 and 91% for pLDH, whereas specificity was 33% and 100%, respectively. The HRP2-based RDTs are useful for initial diagnosis of malaria caused by superior sensitivity; however, as a result of superior specificity, pLDH-based RDTs are more appropriate to monitor treatment and diagnose recurrent malaria.
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Foundation for Innovative New Diagnostics (FIND), Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Infectious Diseases Institute, Kampala, Uganda phibsmm@gmail.com.
authors.forename: Phoebe
authors.initials: P
authors.lastname: Mbabazi
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Foundation for Innovative New Diagnostics (FIND), Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Infectious Diseases Institute, Kampala, Uganda.
authors.forename: Heidi
authors.initials: H
authors.lastname: Hopkins
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Foundation for Innovative New Diagnostics (FIND), Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Infectious Diseases Institute, Kampala, Uganda.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Osilo
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Foundation for Innovative New Diagnostics (FIND), Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Infectious Diseases Institute, Kampala, Uganda.
authors.forename: Michael
authors.initials: M
authors.lastname: Kalungu
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Foundation for Innovative New Diagnostics (FIND), Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Infectious Diseases Institute, Kampala, Uganda.
authors.forename: Pauline
authors.initials: P
authors.lastname: Byakika-Kibwika
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Foundation for Innovative New Diagnostics (FIND), Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Infectious Diseases Institute, Kampala, Uganda.
authors.forename: Moses R
authors.initials: MR
authors.lastname: Kamya
mesh_terms: D000953:Antigens, Protozoan / Q000097:blood; D000962:Antimalarials / Q000627:therapeutic use*; D002675:Child, Preschool; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission; D008297:Male; D015800:Protozoan Proteins / Q000097:blood; D012680:Sensitivity and Specificity; D014454:Uganda / Q000453:epidemiology
chemical_list: D000953:Antigens, Protozoan; D000962:Antimalarials; C514457:HRP-2 antigen, Plasmodium falciparum; D015800:Protozoan Proteins; D007770:L-Lactate Dehydrogenase