Existing rapid diagnostic tests (RDTs) detect current or very recent malaria infections, which means that surveillance programs conducted in regions where few individuals are infected may need to test large numbers of individuals to estimate the transmission intensity. RDTs that detect long-lasting antibodies (‘serology RDTs’) have been proposed as a tool that might help reduce the sampling effort necessary for these low-transmission regions. Because a serology RDT could detect not only currently infected individuals but also individuals who had recovered from infection several months before being tested, it could make it easier to identify villages where limited malaria intervention resources should be directed or villages where local transmission has been interrupted.
We use a mechanistic model of malaria transmission (EMOD) to explore features that would improve the performance of a serology RDT and to determine what characteristics would allow it to outperform existing RDTs. We find serology RDTs that detect infection for a longer period of time after parasite clearance have superior performance compared to those with shorter detection periods, and we identify the sensitivity and specificity benchmarks a serology RDT would need to meet to outperform existing RDTs. By comparing the performance of existing RDTs and hypothetical serology RDTs, this modeling analysis provides information that can help product developers formulate target product profiles and make informed decisions about whether investing in a particular diagnostic tool is worthwhile.
Victoria M Hunt, Christine M Bachman, David Cate, Bernhard H Weigl, David Bell, Chris Drakeley, Jaline Gerardin- Malaria