Assessing the impact of next-generation rapid diagnostic tests on Plasmodium falciparum malaria elimination strategies
Assessing the impact of next-generation rapid diagnostic tests on Plasmodium falciparum malaria elimination strategies
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DOI：
10.1038/nature16040
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发表时间：
2015-12-03
期刊：
影响因子：
64.8
通讯作者：
Ghani, Azra C.
中科院分区：
文献类型：
--
作者：
Slater, Hannah C.;Ross, Amanda;Ghani, Azra C.
正在考虑将大规模筛查和治疗以及有针对性的大规模药物管理战略作为阻断恶性疟原虫疟疾传播的手段。然而，这些策略的有效性将取决于当前和未来的诊断能够在多大程度上检测到那些对蚊子有感染力的个体。我们估计寄生虫密度之间的关系和向前的传染性，使用敏感的定量寄生虫诊断和蚊子喂养试验从布基纳法索。我们发现，检测下限为每微升200个寄生虫的诊断将检测到55%的感染性水库（整个人口的蚊子的综合感染力，按每个人被叮咬的频率加权），而检测下限为每微升20个寄生虫的测试将检测到83%，每微升2个寄生虫将检测到95%的感染性水库。使用数学模型，我们表明，增加诊断灵敏度从200寄生虫每微升（相当于显微镜或目前的快速诊断测试），以2寄生虫每微升将增加区域的数量，其中传输可以中断与大规模屏幕和治疗方案从昆虫接种率低于1到一个高达4。更高灵敏度的诊断可以减少在流行率较低的地区中断传播所需的治疗回合数。我们预测，大规模筛选和治疗与高灵敏度的诊断是有效性低于大规模药物管理，由于后者的方法提供给未感染的个人的预防性保护。在低传播环境，如东南亚，我们发现，诊断工具的灵敏度为20寄生虫每微升可能是足够的有针对性的大规模药物管理，因为这种诊断预计将确定一个类似的村庄人口的患病率相比，目前使用聚合酶链反应检测，如果治疗水平高，筛查是在旱季进行。沿着其他因素，如覆盖范围、药物选择、干预时机、感染输入和季节性，诊断的敏感性可以在增加阻断传播的机会方面发挥作用。
Mass-screen-and-treat and targeted mass-drug-administration strategies are being considered as a means to interrupt transmission of Plasmodium falciparum malaria. However, the effectiveness of such strategies will depend on the extent to which current and future diagnostics are able to detect those individuals who are infectious to mosquitoes. We estimate the relationship between parasite density and onward infectivity using sensitive quantitative parasite diagnostics and mosquito feeding assays from Burkina Faso. We find that a diagnostic with a lower detection limit of 200 parasites per microlitre would detect 55% of the infectious reservoir (the combined infectivity to mosquitoes of the whole population weighted by how often each individual is bitten) whereas a test with a limit of 20 parasites per microlitre would detect 83% and 2 parasites per microlitre would detect 95% of the infectious reservoir. Using mathematical models, we show that increasing the diagnostic sensitivity from 200 parasites per microlitre (equivalent to microscopy or current rapid diagnostic tests) to 2 parasites per microlitre would increase the number of regions where transmission could be interrupted with a mass-screen-and-treat programme from an entomological inoculation rate below 1 to one of up to 4. The higher sensitivity diagnostic could reduce the number of treatment rounds required to interrupt transmission in areas of lower prevalence. We predict that mass-screen-and-treat with a highly sensitive diagnostic is less effective than mass drug administration owing to the prophylactic protection provided to uninfected individuals by the latter approach. In low-transmission settings such as those in Southeast Asia, we find that a diagnostic tool with a sensitivity of 20 parasites per microlitre may be sufficient for targeted mass drug administration because this diagnostic is predicted to identify a similar village population prevalence compared with that currently detected using polymerase chain reaction if treatment levels are high and screening is conducted during the dry season. Along with other factors, such as coverage, choice of drug, timing of the intervention, importation of infections, and seasonality, the sensitivity of the diagnostic can play a part in increasing the chance of interrupting transmission.