Which diagnostic test to use for Testing and Treatment strategies in Plasmodium vivax low-transmission settings: a secondary analysis of a longitudinal interventional study

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas Pub Date : 2024-09-15 DOI:10.1016/j.lana.2024.100883

Hélène Tréhard , Lise Musset , Yassamine Lazrek , Michael White , Stéphane Pelleau , Ivo Mueller , Felix Djossou , Alice Sanna , Jordi Landier , Jean Gaudart , Emilie Mosnier

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引用次数: 0

Abstract

Background

The lack of sensitive field tests to diagnose blood stages and hypnozoite carriers prevents Testing and Treatment (TAT) strategies to achieve Plasmodium vivax elimination in low-transmission settings, but recent advances in Polymerase Chain Reaction (PCR) and serology position them as promising tools. This study describes a PCR-based TAT strategy (PCRTAT) implemented in Saint Georges (SGO), French Guiana, and explores alternative strategies (seroTAT and seroPCRTAT) to diagnose and treat P. vivax carriers.

Methods

The PALUSTOP cohort study implemented in SGO (September 2017 to December 2018) screened participants for P. vivax using PCR tests and treated positive cases. Serology was also performed. Passive detection of P. vivax infection occurred during follow-up. Participants were categorised into overlapping treatment groups based on 2017 PCR and serological results. Strategies were described in terms of participants targeted or missed, primaquine contraindications (pregnancy, G6PD severe or intermediate deficiency), and sociodemographic characteristics.

Findings

In 2017, 1567 inhabitants were included, aged 0–92 years. A total of 90 (6%) were P. vivax carriers and 390 seropositive (25%). PCRTAT missed 282 seropositive individuals while seroTAT would have missed 21 PCR-positive cases. Primaquine contraindications ranged from 12% to 17% across strategies.

Interpretation

Serology and PCR are promising tools for targeted treatment strategies in P. vivax low-transmission settings, when field compatible sensitive tests will be available. Both seem necessary to capture blood stages and potential hypnozoite carriers, while avoiding mass treatment. However, high primaquine contraindications rates need consideration for successful elimination.

Funding

Supported by European Funds for Regional Development, French Guiana Regional Health Agency, Pan American Health Organization, WHO, French Ministry for Research.

查看原文本刊更多论文

在间日疟原虫低传播环境中使用哪种诊断检测来制定检测和治疗策略：对一项纵向干预研究的二次分析

背景由于缺乏敏感的现场检测方法来诊断血期和虫下带原体，因此检测和治疗（TAT）策略无法在低传播环境中消灭间日疟原虫，但聚合酶链式反应（PCR）和血清学的最新进展使它们成为有前途的工具。本研究描述了在法属圭亚那圣乔治（SGO）实施的基于 PCR 的 TAT 策略（PCRTAT），并探讨了诊断和治疗间日疟原虫携带者的替代策略（seroTAT 和 seroPCRTAT）。方法在 SGO 实施的 PALUSTOP 队列研究（2017 年 9 月至 2018 年 12 月）使用 PCR 测试筛查参与者是否携带间日疟原虫，并治疗阳性病例。同时还进行了血清学检测。在随访过程中被动检测了间日疟原虫感染。根据 2017 年 PCR 和血清学结果，将参与者分为重叠治疗组。从目标人群或遗漏人群、伯氨喹禁忌症（怀孕、G6PD重度或中度缺乏）以及社会人口学特征等方面对策略进行了描述。共有 90 人（6%）为间日疟原虫携带者，390 人血清阳性（25%）。PCRTAT 漏检了 282 名血清阳性者，而血清 TAT 会漏检 21 例 PCR 阳性病例。血清学和 PCR 是在间日疟原虫低传播环境中采取有针对性的治疗策略的有效工具。这两种方法似乎对捕获血液阶段和潜在的低原虫携带者都很必要，同时还能避免大规模治疗。然而，要想成功消灭病毒，还需考虑伯氨喹的高禁忌率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lancet Regional Health-Americas Multiple-

CiteScore

8.00

自引率

0.00%

发文量

期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.