Chesnais Cédric B, Awaca-Uvon Naomi-Pitchouna, Bolay Fatoma K, Boussinesq Michel, Fischer Peter U, Gankpala Lincoln, Meite Aboulaye, Missamou François, Pion Sébastien D, Weil Gary J
IRD UMI 233-INSERM U1175-Montpellier University, Montpellier, France.
National Onchocerciasis Control Programme, Ministry of Public Health, Kinshasa, Democratic Republic of the Congo.
PLoS Negl Trop Dis. 2017 Sep 11;11(9):e0005703. doi: 10.1371/journal.pntd.0005703. eCollection 2017 Sep.
The Global Programme to Eliminate Lymphatic Filariasis uses point-of-care tests for circulating filarial antigenemia (CFA) to map endemic areas and for monitoring and evaluating the success of mass drug administration (MDA) programs. We compared the performance of the reference BinaxNOW Filariasis card test (ICT, introduced in 1997) with the Alere Filariasis Test Strip (FTS, introduced in 2013) in 5 endemic study sites in Africa.
The tests were compared prior to MDA in two study sites (Congo and Côte d'Ivoire) and in three sites that had received MDA (DRC and 2 sites in Liberia). Data were analyzed with regard to % positivity, % agreement, and heterogeneity. Models evaluated potential effects of age, gender, and blood microfilaria (Mf) counts in individuals and effects of endemicity and history of MDA at the village level as potential factors linked to higher sensitivity of the FTS. Lastly, we assessed relationships between CFA scores and Mf in pre- and post-MDA settings.
Paired test results were available for 3,682 individuals. Antigenemia rates were 8% and 22% higher by FTS than by ICT in pre-MDA and in post-MDA sites, respectively. FTS/ICT ratios were higher in areas with low infection rates. The probability of having microfilaremia was much higher in persons with CFA scores >1 in untreated areas. However, this was not true in post-MDA settings.
CONCLUSIONS/SIGNIFICANCE: This study has provided extensive new information on the performance of the FTS compared to ICT in Africa and it has confirmed the increased sensitivity of FTS reported in prior studies. Variability in FTS/ICT was related in part to endemicity level, history of MDA, and perhaps to the medications used for MDA. These results suggest that FTS should be superior to ICT for mapping, for transmission assessment surveys, and for post-MDA surveillance.
全球消除淋巴丝虫病规划使用即时检测法检测循环丝虫抗原血症（CFA），以绘制流行区域地图，并监测和评估大规模药物治疗（MDA）项目的成效。我们在非洲的5个流行研究地点比较了参考检测方法BinaxNOW丝虫病卡片检测（ICT，1997年推出）与Alere丝虫病检测试纸条（FTS，2013年推出）的性能。
在两个研究地点（刚果和科特迪瓦）的MDA之前以及在三个接受过MDA的地点（刚果民主共和国和利比里亚的2个地点）对检测方法进行比较。分析了阳性率、一致性百分比和异质性的数据。模型评估了个体年龄、性别和血液微丝蚴（Mf）计数的潜在影响，以及村庄层面的流行程度和MDA历史作为与FTS更高敏感性相关的潜在因素的影响。最后，我们评估了MDA前后环境中CFA分数与Mf之间的关系。
有3682名个体的配对检测结果可用。在MDA之前和之后的地点，FTS检测的抗原血症率分别比ICT检测高8%和22%。在感染率低的地区，FTS/ICT比率更高。在未治疗地区，CFA分数>1的人患微丝蚴血症的可能性要高得多。然而，在MDA之后的环境中并非如此。
结论/意义：本研究提供了关于FTS与ICT在非洲性能比较的大量新信息，并证实了先前研究中报道的FTS敏感性增加。FTS/ICT的变异性部分与流行程度、MDA历史有关，可能还与MDA使用的药物有关。这些结果表明，FTS在绘制地图、传播评估调查和MDA后监测方面应优于ICT。
