Practicability of a malaria rapid diagnostic self-test among artisanal gold miners in French Guiana: a cross-sectional study.

BACKGROUND

In French Guiana (FG), artisanal and small-scale gold mining (ASGM) workers represent mobile, hard-to-reach population with high malaria burden. Limited access to rapid diagnostic test (RDT) delays treatment, favours inappropriate use of artemisinin-based combination therapy (ACT), and increases transmission and resistance risk. The Malakit intervention enables ASGM workers to self-diagnose and self-treat using RDTs and ACT in a free kit distributed by community health workers (CHWs) after a dedicated training session. This cross-sectional study assessed the praticability of the Bioline Malaria Ag P.f/P.f/P.v RDT among ASGM workers.

METHODS

During Malakit training sessions, an independent observer evaluated participants' knowledge of RDT use, ability to perform self-testing, and ability to interpret results. Each assessment was conducted using a specific tool and quantified with a corresponding sub-score, which were then combined in an overall practicability score. Associations with socio-demographic characteristics were explored using multiple linear regressions.

RESULTS

From May to June 2024 forty participants were enrolled in Oiapoque, Brazil. The male-to-female sex ratio was 2.64 and median age 37 years [IQR 31.8-48.8]; 27.5% had no formal education. Following training, mean scores were: knowledge 83.9% [CI95 79.6-88.2], practice 84.6% [CI95 78.3-90.9] without assistance (100% with guidance) and interpretation 77.2% [CI95 70.7-83.8]. All RDTs performed yielded valid result. Correct interpretation rates were 96.0% [CI95 92.4-99.6] for positive strips, 70.0% [CI95 55.2-84.8] for negative strips, and 65.8% [CI95 56.6-75.0] for invalid strips. The overall practicability score was 81.9% [CI95 78.3-85.6]. In practice, all obtained a valid test (presence of the control strip).

CONCLUSIONS

The study demonstrated the practicability of malaria self-testing among non-professional users after structured training, with ASGM workers achieving an overall practicability score of 81.9%. Participants successfully performed RDTs (100% valid results with guidance) and accurately interpreted positive results (96.0%). This methodology provides a replicable framework for evaluating self-diagnostic strategies in hard-to-reach populations and supports integration of community-based malaria diagnosis into elimination programmes.