Nature communications · 2020
Modelling the incremental benefit of introducing malaria screening strategies to antenatal care in Africa.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Walker Patrick G T, Cairns Matt, Slater Hannah, Gutman Julie, Kayentao Kassoum, Williams John E, Coulibaly Sheick O, Khairallah Carole, Taylor Steve, Meshnick Steven R, Hill Jenny, Mwapasa Victor, Kalilani-Phiri Linda, Bojang Kalifa, Kariuki Simon, Tagbor Harry, Griffin Jamie T, Madanitsa Mwayi, Ghani Azra C H, Desai Meghna, Ter Kuile Feiko O
Аннотация
Plasmodium falciparum in pregnancy is a major cause of adverse pregnancy outcomes. We combine performance estimates of standard rapid diagnostic tests (RDT) from trials of intermittent screening and treatment in pregnancy (ISTp) with modelling to assess whether screening at antenatal visits improves upon current intermittent preventative therapy with sulphadoxine-pyrimethamine (IPTp-SP). We estimate that RDTs in primigravidae at first antenatal visit are substantially more sensitive than in non-pregnant adults (OR = 17.2, 95% Cr.I. 13.8-21.6), and that sensitivity declines in subsequent visits and with gravidity, likely driven by declining susceptibility to placental infection. Monthly ISTp with standard RDTs, even with highly effective drugs, is not superior to monthly IPTp-SP. However, a hybrid strategy, recently adopted in Tanzania, combining testing and treatment at first visit with IPTp-SP may offer benefit, especially in areas with high-grade SP resistance. Screening and treatment in the first trimester, when IPTp-SP is contraindicated, could substantially improve pregnancy outcomes.