Impact of malaria diagnostic choice on monitoring of Plasmodium falciparum prevalence estimates in the Democratic Republic of the Congo and relevance to control programs in high-burden countries

• DOI: 10.1371/journal.pgph.0001375
• Publication Date: 2023-07-26T18:30:25Z
• Authors: Alpha Oumar Diallo; Kristin Banek; Melchior Mwandaga...; Joseph Alexandre ...; Marthe Nkalani; Georges Kihuma; Tommy Mambulu Nseka; Joseph Losoma Atibu; Georges Emo Mahilu; Lauren McCormick; Samuel J. White; Rachel Sendor; Cyrus Sinai; Corinna Keeler; Camelia Herman; Michael Emch; Eric Sompwe; Kyaw Lay Thwai; Rhoel R. Dinglasan; Eric Rogier; Jonathan J. Juliano; Antoinette Kitoto...; Jonathan B. Parr
• Keywords: Rapid diagnostic test; Gold standard (test)

Malaria programs rely upon a variety of diagnostic assays, including rapid tests (RDTs), microscopy, polymerase chain reaction (PCR), and bead-based immunoassays (BBA), to monitor malaria prevalence support control elimination efforts. Data comparing these assays are limited, especially from high-burden countries like the Democratic Republic Congo (DRC). Using cross-sectional routine data, we compared performance Plasmodium falciparum estimates across health areas varying transmission intensity illustrate relevance assay programs. samples were collected between March–June 2018 during household survey three with low, moderate, high intensities within Kinshasa Province, DRC. Samples 1,431 participants evaluated using RDT, PCR, BBA. P . parasite varied methods all areas, highest observed in Bu (57.4–72.4% assays), followed by Kimpoko (32.6–53.2%), Voix du Peuple (3.1–8.4%). latent class analysis compare against an “alloyed gold standard,” most sensitive method was BBA (high prevalence) (low prevalence), while PCR diagnosis (moderate prevalence). RDTs consistently specific areas. Among 9.0 million people residing Province 2018, estimated nearly double that RDT. Comparison results confirmed differences sensitivity specificity endemicity, performing best for detecting any infection. Prevalence widely depending on type detection. Inherent should be carefully considered when community surveillance data guide policy decisions.