title: Performance and time to become negative after treatment of three malaria rapid diagnostic tests in low and high malaria transmission settings.
abstract: The performance of different malaria rapid diagnostic tests (RDT) may be influenced by transmission intensity and by the length of time each test requires to become negative after treatment and patient's recovery.
  
  
  
  Results of three RDTs (two HRP2 and one pLDH antigen-based tests) were compared to blood smear microscopy (the gold standard method) in children under 5 years of age living in a high versus low malaria intensity setting in southwestern Uganda. In each setting, 212 children, who tested positive by at least one RDT and by microscopy, were treated with artemether-lumefantrine. RDTs and microscopy were then repeated at fixed intervals to estimate each test's time to negativity after treatment and patient recovery.
  
  
  
  In the two settings, sensitivities ranged from 98.4 to 99.2 % for the HRP2 tests and 94.7 to 96.1 % for the pLDH test. Specificities were 98.9 and 98.8 % for the HRP2 tests and 99.7 % for the pLDH test in the low-transmission setting and 79.7, 80.7 and 93.9 %, respectively, in the high-transmission setting. Median time to become negative was 35-42 or more days for the HRP2 tests and 2 days for the pLDH test.
  
  
  
  High transmission contexts and a long time to become negative resulted in considerably reduced specificities for the HRP2 tests. Choice of RDT for low- versus high-transmission settings should balance risks and benefits of over-treatment versus missing malaria cases.
  
  
  
  Registry number at ClinicalTrial.gov: NCT01325974.
authors.affiliation: Epicentre, 8 rue Saint-Sabin, Paris, France. francesco.GRANDESSO@epicentre.msf.org.
authors.forename: Francesco
authors.identifier: 0000-0001-9909-0285
authors.initials: F
authors.lastname: Grandesso
authors.affiliation: Epicentre Mbarara Research Centre, Mbarara, Uganda.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Nabasumba
authors.affiliation: Epicentre Mbarara Research Centre, Mbarara, Uganda.
authors.forename: Dan
authors.initials: D
authors.lastname: Nyehangane
authors.affiliation: Epicentre, 8 rue Saint-Sabin, Paris, France.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Page
authors.affiliation: Epicentre, 8 rue Saint-Sabin, Paris, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Bastard
authors.affiliation: Médecins Sans Frontières, Brussels, Belgium.
authors.forename: Martin
authors.initials: M
authors.lastname: De Smet
authors.affiliation: Epicentre Mbarara Research Centre, Mbarara, Uganda.|Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Yap
authors.initials: Y
authors.lastname: Boum
authors.affiliation: Epicentre, 8 rue Saint-Sabin, Paris, France.|UMI 233 TransVIHMI, Institut de Recherche pour le Développement, Université de Montpellier 1, 34000, Montpellier, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Etard
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000627:therapeutic use*; D002675:Child, Preschool; D002846:Chromatography, Affinity / Q000379:methods*; D003955:Diagnostic Tests, Routine / Q000379:methods*; D004338:Drug Combinations; D004983:Ethanolamines / Q000627:therapeutic use*; D005260:Female; D005449:Fluorenes / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008853:Microscopy; D012680:Sensitivity and Specificity; D013997:Time Factors; D014454:Uganda
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes
keywords: Diagnostic; Fever; Malaria; Negativity; Performance; Rapid diagnostic test; Sensitivity; Specificity