HIV This Week

Utility of a Point-of-Care Malaria Rapid Diagnostic Test for Excluding Malaria as the Cause of Fever among HIV-Positive Adults in Rural Rakai, Uganda.

Mills L, Kagaayi J, Nakigozi G, Galiwango R, Ouma J, Shott J, Ssempijja V, Gray R, Wawer M, Serwadda D, Quinn T, and Reynolds S. Am. J. Trop. Med. Hyg. 2010. 82:145-147.

Mills and colleagues compared results of a malaria rapid diagnostic test (Binax Now ® Malaria, Binax-M, Inverness Medical Innovations, Inc., Waltham, MA) performed at rural mobile clinics in Uganda by clinicians evaluating febrile adult HIV patients to thick smear evaluated at a central laboratory by trained microscopists. Two hundred forty-six samples were analyzed, including 14 (5.7%) which were thick-smear positive for falciparum malaria. Sensitivity of Binax-M compared with thick smear was 85.7% (95% CI: 57.2–98.2), specificity 97.8% (95% CI: 94.9–99.3), positive and negative predictive values were 70.6% (95% CI: 44.0–89.7) and 99.1% (95% CI: 96.8–99.9), respectively. The rapid diagnostic test accurately ruled malaria "in or out" at the point-of-care, facilitating appropriate clinical management and averting unnecessary anti-malarial therapy.

For abstract access click here: 1 

Editors’ note: Through a PEPFAR-funded mobile HIV clinic programme, most participants in this study in a falciparum malaria endemic district in Uganda had received insecticide treated bed nets, cotrimoxasole prophylaxis regardless of CD4 count, and antiretroviral treatment if their CD4 counts fell below 250 cells/ µ l. With malaria suspected in 41.5% of general out-patient visits in this district, use of this point-of-care test in people living with HIV who presented with fever allowed health care providers to focus on other urgent causes of fever. The test had a high negative predictive value, meaning that a negative test was highly likely to mean that the person did not have malaria.