Efficiency of a Malaria Reactive Test-and-Treat Program in Southern Zambia: A Prospective, Observational Study

Molly Deutsch-Feldman Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina;

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Harry Hamapumbu Macha Research Trust, Choma District, Zambia;

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Jailos Lubinda Macha Research Trust, Choma District, Zambia;

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Michael Musonda Macha Research Trust, Choma District, Zambia;

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Ben Katowa Macha Research Trust, Choma District, Zambia;

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Kelly M. Searle Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland;

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Tamaki Kobayashi Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland;

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Timothy M. Shields Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland;

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Jennifer C. Stevenson Macha Research Trust, Choma District, Zambia;
Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland

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Philip E. Thuma Macha Research Trust, Choma District, Zambia;
Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland

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William J. Moss Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland;
Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland

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for the Southern Africa International Centers of Excellence for Malaria Research Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina;
Macha Research Trust, Choma District, Zambia;
Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland;
Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland

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To improve malaria surveillance and achieve elimination, the Zambian National Malaria Elimination Program implemented a reactive test-and-treat program in Southern Province in 2013 in which individuals with rapid diagnostic test (RDT)–confirmed malaria are followed-up at their home within 1 week of diagnosis. Individuals present at the index case household and those residing within 140 m of the index case are tested with an RDT and treated with artemether–lumefantrine if positive. This study evaluated the efficiency of this reactive test-and-treat strategy by characterizing infected individuals missed by the RDT and the current screening radius. The radius was expanded to 250 m, and a quantitative polymerase chain reaction (qPCR) test was performed on dried blood spot specimens. From January 2015 through March 2016, 145 index cases were identified at health centers and health posts. A total of 3,333 individuals residing in 525 households were screened. Excluding index cases, the parasite prevalence was 1.1% by RDT (33 positives of 3,016 participants) and 2.4% by qPCR (73 positives of 3,016 participants). Of the qPCR-positive cases, 62% of 73 individuals tested negative by RDT. Approximately half of the infected individuals resided within the index case household (58% of RDT-positive individuals and 48% of qPCR-positive individuals). The low sensitivity of the RDT and the high proportion of secondary cases within the index case household decreased the efficiency of this reactive test-and-treat strategy. Reactive focal drug administration in index case households would be a more efficient approach to treating infected individuals associated with a symptomatic case.

Author Notes

Address correspondence to Molly Deutsch-Feldman, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC. E-mail: mollydf1@live.unc.edu

Financial support: This work was supported by the Johns Hopkins Malaria Research Institute, the Bloomberg Philanthropies, and the Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases as part of the International Centers of Excellence for Malaria Research (U19AI089680).

Authors’ addresses: Molly Deutsch-Feldman, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, E-mail: mollydf1@live.unc.edu. Harry Hamapumbu, Jailos Lubinda, Michael Musonda, and Ben Katowa, Macha Research Trust, Choma District, Zambia, E-mails: harry.hamapumbu@macharesearch.org, jailoslubinda@gmail.com, michael.musonda@macharesearch.org, and ben.katowa@macharesearch.org. Kelly M. Searle, Tamaki Kobayashi, and Timothy M. Shields, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, E-mails: ksearle1@jhu.edu, tkobaya2@jhu.edu, and tshields@jhu.edu. Jennifer C. Stevenson and Philip E. Thuma, Macha Research Trust, Choma District, Zambia, and Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, E-mails: jennyc.stevenson@macharesearch.org and phil.thuma@macharesearch.org. William J. Moss, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, and Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, E-mail: wmoss1@jhu.edu.

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