Test and treat for malaria

Study shows need to educate health providers to use diagnostic tests before treating

TDR news item
10 December 2013

A new study investigating the factors influencing the uptake of the World Health Organization’s policy of “test and treat” for malaria identifies the need to help health providers become more confident in diagnostic results. Even with national policies in place requiring this, providers do not always use the tests and treat accordingly.

The study examined more than 115 000 records in southern Senegal from 2000-2011. The results suggest that national policies alone are insufficient to guarantee the adoption of test and treat policies, and policy-makers should encourage education that focuses on improving health providers’ confidence in test results.

Policy-makers should encourage education that focuses on improving health providers’ confidence in test results.

Study author recommendations

Global malaria treatment policy has changed from treating whenever there is a fever (assuming the cause is malaria) to treating with artemisinin combination therapy (ACT) only after a positive rapid diagnostic test (RDT). This transition involves changing long-standing behavior among health providers and patients, which results in a delay between the introduction and full implementation.

The study found that ACT usage was not a complete indicator of effective implementation of the policy. Reliance on diagnostic tests is a better indicator, since ACTs could still be provided without a test. Diagnostic tests help prevent incorrect and/or delayed treatment, as well as prevent parasite resistance to the medicines. The study found that health providers’ belief in the accuracy of RDTs precedes full adoption of test and treat, suggesting this is a behavior to target to expedite its uptake. When malaria tests are unavailable, or not administered, health providers compensate by relying on environmental predictors (such as rainfall) which leads to over-diagnosis.

The study also found that, although there may be long lead-times after national policies are created, once adoption of clinical behaviors begins, full transition to the desired behavior can occur quickly and completely.

The study was a collaboration between TDR, the Universities of Princeton (USA) and Oxford (UK), L'Institut de recherche pour le développement (IRD) in Senegal, and the Public Research Centre for Health (CRP-Santé) in Luxembourg. Results were presented at the 2013 annual meeting of the American Society of Tropical Medicine & Hygiene.

For more information, please contact

Piero Olliaro