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COMPARISON OF HRP2- AND pLDH-BASED RAPID DIAGNOSTIC TESTS FOR MALARIA WITH LONGITUDINAL FOLLOW-UP IN KAMPALA, UGANDA

Presumptive treatment of malaria results in significant overuse of antimalarials. Malaria rapid diagnostic tests (RDTs) may offer a reliable alternative for case management, but the optimal RDT strategy is uncertain. We compared the diagnostic accuracy of histidine-rich protein 2 (HRP2)- and plasmodium lactate dehydrogenase (pLDH)-based RDTs, using expert microscopy as the gold standard, in a longitudinal study of 918 fever episodes over an 8-month period in a cohort of children in Kampala, Uganda. Sensitivity was 92% for HRP2 and 85% for pLDH, with differences primarily due to better detection with HRP2 at low parasite densities. Specificity was 93% for HRP2 and 100% for pLDH, with differences primarily due to rapid clearance of pLDH antigenemia after treatment of a previous malaria episode. RDTs may provide an effective strategy for improving rational delivery of antimalarial therapy; in Kampala, either test could dramatically decrease inappropriate presumptive treatments.

Received January 12, 2007. Accepted for publication February 21, 2007.

Acknowledgments: The authors thank the study participants and their families, and Makerere University–University of California, San Francisco (MU-UCSF) Malaria Research Collaboration clinic and laboratory staff, including Regina Nakafeero, Maxwell Kilama, Christopher Bongole, Felix Jurua, Irene Namukwaya, Denise Njama-Meya, Bridget Nzarubara, Catherine Maiteki, Joy Bossa, Ruth Namuyinga, Arthur Mpimbaza, Joanita Nankabirwa, Florence Nankya, and Moses Musinguzi. We are grateful to Sam Nsobya, Moses Kiggundu, and Chris Dokomajilar for assistance with molecular studies, to John Patrick Mpindi and Geoff Lavoy for assistance with computer maintenance and data management, and to Catherine Tugaineyo, Richard Oluga, Kenneth Mwebaze, and Peter Padilla for administrative support. The authors thank Carole Fogg and Patrice Piola of MSF/Epicentre for providing preliminary data from an RDT study in Mbarara, western Uganda. We also thank the U.S. National Institutes of Health and the Doris Duke Charitable Foundation for their support. P.J.R. is a Doris Duke Charitable Foundation Distinguished Clinical Scientist.

Financial support: This study was funded by the U.S. National Institutes of Health (grant K23 AI065457-01), with additional support received from the Doris Duke Charitable Foundation.

^* Address correspondence to H. Hopkins, c/o Makerere University–University of California, San Francisco, Malaria Research Collaboration, P.O. Box 7475, Kampala, Uganda. E-mail: hhopkins{at}medsfgh.ucsf.edu

Authors’ addresses: Heidi Hopkins, University of California, San Francisco, c/o MU-UCSF Malaria Research Collaboration, P.O. Box 7475, Kampala, Uganda, Telephone/Fax: +256-414-540524, E-mail: hhopkins{at}medsfgh.ucsf.edu. Kambale Wilson, MU-UCSF Malaria Research Collaboration, P.O. Box 7475, Kampala, Uganda, Telephone: +256-414-530692, Fax: +256-414-540524. Moses R. Kamya, Makerere University Medical School, P.O. Box 7072, Kampala, Uganda, Telephone: +256-414-541188, Fax: +256-414-540524. Sarah Staedke, London School of Hygiene & Tropical Medicine, c/o MU-UCSF Malaria Research Collaboration, P.O. Box 7475, Kampala, Uganda, Telephone: +256-414-530692, Fax: +256-414-540524. Grant Dorsey and Philip J. Rosenthal, University of California, San Francisco, Parnassus Avenue, Box 0811, San Francisco, CA 94143, Telephone: +1 (415) 648-4680, Fax: +1 (415) 648-8425.

Reprint requests: H. Hopkins, c/o Makerere University–University of California, San Francisco Malaria Research Collaboration, P.O. Box 7475, Kampala, Uganda, Telephone/Fax: +256-414-540524, E-mail: hhopkins{at}medsfgh.ucsf.edu.

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