{
    "abstract": "The standard malaria rapid diagnostic test (RDT) and newer ultra-sensitive RDT (uRDT) target Plasmodium falciparum histidine rich protein-2 (HRP2), which persists post-treatment. The duration of test positivity has not previously been studied in a low transmission setting.\nWe conducted a longitudinal cohort study in a low transmission setting in Namibia. RDT-positive individuals identified through passive and active case detection were treated and followed weekly for testing by RDT and uRDT, HRP2 quantification, quantitative PCR (qPCR) of parasitemia, and quantitative reverse transcriptase PCR (RT-PCR) of gametocytemia, until RDT and uRDT were negative for two consecutive weeks. Determinants of persistent positivity were identified using Cox proportional hazards models.\nAmong 137 participants with complete follow-up and no evidence of resurgence during follow-up, median duration of positivity was 42 days (range: 3-98 range) for RDT, compared to 67 days (range 12-105) for uRDT. In a sub-analysis of those with laboratory data before treatment (n\u00a0=\u00a060), drug resistance did not explain persistent positivity. Younger age (<15 years versus \u226515 years: aHR: 1.85, 95% CI 1.04-3.30, and 1.67, 95% CI 0.96-2.89, for RDT and uRDT, respectively), higher initial parasite density (highest versus lowest tertile: aHR 0.11, 95% CI 0.04-0.32 and 0.19, 95% CI 0.07-0.48 for RDT and uRDT, respectively), and persistent parasitemia (\u22657 days versus reference of <7 days, aHR 0.39, 95% CI 0.20-0.76, and 0.40, 95% CI 0.21-0.76 for RDT and uRDT, respectively) were associated with longer duration of positivity.\nDuration of RDT/uRDT positivity was more than double compared to reports from higher endemic settings, potentially due to lower population immunity to clear parasite DNA and antigen. Prolonged duration of positivity compromises their use to detect current infection, but increased detection of recent infection can facilitate surveillance and inform elimination efforts.\nThe project was funded by the Bill and Melinda Gates Foundation (A128488 and INV1135840), Horchow Family Fund (5300375400), and Chan Zuckerberg Biohub.",
    "authors": [
        {
            "affiliation": "Malaria Elimination Initiative, Global Health Group, University of California, San Francisco (UCSF), San Francisco 94158, USA.",
            "firstname": "Henry",
            "initials": "H",
            "lastname": "Ntuku"
        },
        {
            "affiliation": "Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75390, USA.",
            "firstname": "Brooke",
            "initials": "B",
            "lastname": "Whittemore"
        },
        {
            "affiliation": "Multidisciplinary Research Centre, University of Namibia, Windhoek 13301, Namibia.",
            "firstname": "Lucille",
            "initials": "L",
            "lastname": "Dausab"
        },
        {
            "affiliation": "Diagnostics Program, PATH, Seattle 98121, USA.",
            "firstname": "Ihn Kyung",
            "initials": "IK",
            "lastname": "Jang"
        },
        {
            "affiliation": "Diagnostics Program, PATH, Seattle 98121, USA.",
            "firstname": "Allison",
            "initials": "A",
            "lastname": "Golden"
        },
        {
            "affiliation": "Diagnostics Program, PATH, Seattle 98121, USA.",
            "firstname": "William",
            "initials": "W",
            "lastname": "Sheahan"
        },
        {
            "affiliation": "Malaria Elimination Initiative, Global Health Group, University of California, San Francisco (UCSF), San Francisco 94158, USA.",
            "firstname": "Xue",
            "initials": "X",
            "lastname": "Wu"
        },
        {
            "affiliation": "Diagnostics Program, PATH, Seattle 98121, USA.",
            "firstname": "Hannah",
            "initials": "H",
            "lastname": "Slater"
        },
        {
            "affiliation": "Diagnostics Program, PATH, Seattle 98121, USA.",
            "firstname": "Gonzalo J",
            "initials": "GJ",
            "lastname": "Domingo"
        },
        {
            "affiliation": "Diagnostics Program, PATH, Seattle 98121, USA.",
            "firstname": "Smita",
            "initials": "S",
            "lastname": "Das"
        },
        {
            "affiliation": "Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, UCSF, San Francisco 94158, USA.",
            "firstname": "Elias",
            "initials": "E",
            "lastname": "Duarte"
        },
        {
            "affiliation": "Multidisciplinary Research Centre, University of Namibia, Windhoek 13301, Namibia.",
            "firstname": "Lydia",
            "initials": "L",
            "lastname": "Eloff"
        },
        {
            "affiliation": "Radboud University Medical Centre, Nijmegen 6500HB, the Netherlands.",
            "firstname": "Teun",
            "initials": "T",
            "lastname": "Bousema"
        },
        {
            "affiliation": "Radboud University Medical Centre, Nijmegen 6500HB, the Netherlands.",
            "firstname": "Kjerstin",
            "initials": "K",
            "lastname": "Lanke"
        },
        {
            "affiliation": "Malaria Elimination Initiative, Global Health Group, University of California, San Francisco (UCSF), San Francisco 94158, USA.",
            "firstname": "Cara Smith",
            "initials": "CS",
            "lastname": "Gueye"
        },
        {
            "affiliation": "Malaria Elimination Initiative, Global Health Group, University of California, San Francisco (UCSF), San Francisco 94158, USA.",
            "firstname": "Lisa M",
            "initials": "LM",
            "lastname": "Prach"
        },
        {
            "affiliation": "Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Sandringham, Johannesburg, Gauteng, South Africa.",
            "firstname": "Jaishree",
            "initials": "J",
            "lastname": "Raman"
        },
        {
            "affiliation": "Namibia Ministry of Health and Social Services, Windhoek 13198, Namibia.",
            "firstname": "Petrina",
            "initials": "P",
            "lastname": "Uusiku"
        },
        {
            "affiliation": "Namibia Ministry of Health and Social Services, Windhoek 13198, Namibia.",
            "firstname": "Stark",
            "initials": "S",
            "lastname": "Katokele"
        },
        {
            "affiliation": "Malaria Elimination Initiative, Global Health Group, University of California, San Francisco (UCSF), San Francisco 94158, USA.",
            "firstname": "Roly",
            "initials": "R",
            "lastname": "Gosling"
        },
        {
            "affiliation": "Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, UCSF, San Francisco 94158, USA.",
            "firstname": "Bryan",
            "initials": "B",
            "lastname": "Greenhouse"
        },
        {
            "affiliation": "Multidisciplinary Research Centre, University of Namibia, Windhoek 13301, Namibia.",
            "firstname": "Davis",
            "initials": "D",
            "lastname": "Mumbengegwi"
        },
        {
            "affiliation": "Malaria Elimination Initiative, Global Health Group, University of California, San Francisco (UCSF), San Francisco 94158, USA; Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75390, USA; Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco 94158, USA; Department of Epidemiology and Biostatistics, UCSF, San Francisco 94158, USA. Electronic address: michelle.hsiang@ucsf.edu.",
            "firstname": "Michelle S",
            "initials": "MS",
            "lastname": "Hsiang"
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2024 The Authors. Published by Elsevier B.V. All rights reserved.",
    "doi": "10.1016/j.ebiom.2024.105489",
    "journal": "EBioMedicine",
    "keywords": [
        "Histidine-rich protein",
        "Low transmission",
        "Low-endemic",
        "Malaria",
        "Malaria elimination",
        "Persistence"
    ],
    "methods": null,
    "publication_date": "2024-12-11",
    "pubmed_id": "39657364\n37360963\n29034876\n11781267\n21735422\n37661286\n26633770\n28820709\n11355555\n31848119\n29460730\n34580442\n30567537\n30404944\n25734259\n25256904\n30497508\n28719294\n33107430\n31438951\n29884184\n36474274\n32883286\n19735557\n34082776\n35993723\n29220497\n35922803\n32898225\n32334702\n39226907",
    "results": null,
    "title": "Post-treatment duration of positivity for standard and ultra-sensitive Plasmodium falciparum antigen-based rapid diagnostic tests, a cohort study from a low-endemic setting in Namibia.",
    "xml": "<Element 'PubmedArticle' at 0x788505f80950>"
}