Ghouth Abdulla Salim Bin, Nasseb Faraj Mubarak, Al-Kaldy Khaled Hussin
Department of Family Medicine, Hadramout University, Malaria Control Program (Hadramout region/Yemen), Yemen.
Trop Parasitol. 2012 Jan;2(1):35-7. doi: 10.4103/2229-5070.97237.
Recent WHO guidelines recommended a universal "test and treat" strategy for malaria mainly by use of the rapid diagnostic test (RDT) in all areas. There are concerns about RDT that use the antigen histidine-rich protein2 (HRP2) to detect Plasmodium falciparum, because infection can persist after effective treatment.
The aim of this paper is to describe the accuracy of the first response (HRP2)-RDT compared with malaria microscopy used for guiding the field treatment of patients in an outbreak situation in the Al-Rahabah area in Al-Rydah district in Hadramout/Yemen.
An ad hoc cross sectional survey of all febrile patients in the affected area was conducted in May 2011. The field team was developed including the case management group and the entomology group. The group of case management prepared their plan based on "test and treat" strategy by using First Response Malaria Antigen HRP2 rapid diagnostic test for falciparum malaria, artemsinin-based combination therapy (ACT) according to the national policy of anti-malaria drugs in Yemen were supplied to treat those who were found to be RDT positive in the field; also blood smear films were taken from every patient with fever in order to validate the use of the RDT in the field. Blood film slides prepared and read by skilled lab technicians, the fourth reading was done by one lab expert in the malaria referral lab.
The accuracy parameters of HRP2 compared with microscopy are: Sensitivity (74%), specificity (94%). The positive predictive value is 68% and the negative predictive value is 96%. Total agreement is 148/162 (93%) and the overall prevalence is 14%. All the positive malaria cases were of P. falciparum either coming from RDT or microscopy.
HRP2-rapid test is an acceptable test as a guide for field treatment in an outbreak situation where prompt response is indicated. Good prepared blood film slides should be used as it is feasible to evaluate the accuracy of RDTs as a quality control tool.
世界卫生组织最近的指南建议在所有地区主要通过使用快速诊断检测（RDT）对疟疾采取普遍的“检测并治疗”策略。对于使用富含组氨酸蛋白2（HRP2）抗原检测恶性疟原虫的RDT存在担忧，因为有效治疗后感染可能持续存在。
本文旨在描述在也门哈德拉毛省赖代区拉哈巴地区的一次疫情中，与用于指导患者现场治疗的疟疾显微镜检查相比，第一代快速检测（HRP2）-RDT的准确性。
2011年5月对受影响地区的所有发热患者进行了一次临时横断面调查。组建了现场团队，包括病例管理组和昆虫学组。病例管理组根据“检测并治疗”策略制定计划，使用第一代疟疾抗原HRP2快速诊断检测来检测恶性疟原虫，按照也门国家抗疟药物政策提供以青蒿素为基础的联合疗法（ACT）来治疗在现场检测为RDT阳性的患者；还对每位发热患者进行血涂片检查，以验证现场RDT的使用情况。血涂片玻片由熟练的实验室技术人员制备和读取，第四次读取由疟疾转诊实验室的一名实验室专家完成。
与显微镜检查相比，HRP2的准确性参数为：灵敏度（74%），特异性（94%）。阳性预测值为68%，阴性预测值为96%。总一致性为148/162（93%），总体患病率为14%。所有阳性疟疾病例均为恶性疟原虫，无论是通过RDT还是显微镜检查检测出的。
在需要迅速应对的疫情情况下，HRP2快速检测作为现场治疗的指导是一种可接受的检测方法。应使用制备良好的血涂片玻片，因为将其作为质量控制工具来评估RDT的准确性是可行的。
