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Modelling the incremental benefit of introducing malaria screening strategies to antenatal care in Africa

Article scientifique 2020 Anglais

Résumé

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.

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Walker, P., Cairns, M., Slater, H., Gutman, J., Kayentao, K., Williams, J., Coulibaly, S., Khairallah, C., Taylor, S., Meshnick, S., Mwapasa, V., Kalilani‐Phiri, L., Bojang, K., Kariuki, S., Tagbor, H., Griffin, J., Madanitsa, M., Ghani, A., Desai, M., Kuile, F. (2020). Modelling the incremental benefit of introducing malaria screening strategies to antenatal care in Africa. https://doi.org/10.1038/s41467-020-17528-3

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Auteur(s)

Patrick Walker Matthew Cairns Hannah Slater Julie Gutman Kassoum Kayentao John E. Williams Sheick Oumar Coulibaly Carole Khairallah Steve M. Taylor Steven R. Meshnick Victor Mwapasa Linda Kalilani‐Phiri Kalifa Bojang Simon Kariuki Harry Tagbor Jamie T. Griffin Mwayi Madanitsa Azra C. Ghani Meghna Desai Feiko O. ter Kuile

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