Evidence map›Paper›PMID 39657364›Full record

ArticleEBioMedicine2025

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.

Henry Ntuku, Brooke Whittemore, Lucille Dausab, Ihn Kyung Jang, Allison Golden, William Sheahan, Xue Wu, Hannah Slater, Gonzalo J Domingo, Smita Das and 13 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in EBioMedicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Challenges in Malaria Diagnosis and Treatment in Kinshasa Province, Democratic Republic of the Congo.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026
    Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

23 authors.

Henry NtukuMalaria Elimination Initiative, Global Health Group, University of California, San Francisco (UCSF), San Francisco 94158, USA.
Brooke WhittemoreDepartment of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75390, USA.
Lucille DausabMultidisciplinary Research Centre, University of Namibia, Windhoek 13301, Namibia.
Ihn Kyung JangDiagnostics Program, PATH, Seattle 98121, USA.
Allison GoldenDiagnostics Program, PATH, Seattle 98121, USA.
William SheahanDiagnostics Program, PATH, Seattle 98121, USA.
Xue WuMalaria Elimination Initiative, Global Health Group, University of California, San Francisco (UCSF), San Francisco 94158, USA.
Hannah SlaterDiagnostics Program, PATH, Seattle 98121, USA.
Gonzalo J DomingoDiagnostics Program, PATH, Seattle 98121, USA.
Smita DasDiagnostics Program, PATH, Seattle 98121, USA.
Elias DuarteDivision of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, UCSF, San Francisco 94158, USA.
Lydia EloffMultidisciplinary Research Centre, University of Namibia, Windhoek 13301, Namibia.
Teun BousemaRadboud University Medical Centre, Nijmegen 6500HB, the Netherlands.
Kjerstin LankeRadboud University Medical Centre, Nijmegen 6500HB, the Netherlands.
Cara Smith GueyeMalaria Elimination Initiative, Global Health Group, University of California, San Francisco (UCSF), San Francisco 94158, USA.
Lisa M PrachMalaria Elimination Initiative, Global Health Group, University of California, San Francisco (UCSF), San Francisco 94158, USA.
Jaishree RamanCentre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Sandringham, Johannesburg, Gauteng, South Africa.
Petrina UusikuNamibia Ministry of Health and Social Services, Windhoek 13198, Namibia.
Stark KatokeleNamibia Ministry of Health and Social Services, Windhoek 13198, Namibia.
Roly GoslingMalaria Elimination Initiative, Global Health Group, University of California, San Francisco (UCSF), San Francisco 94158, USA.
Bryan GreenhouseDivision of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, UCSF, San Francisco 94158, USA.
Davis MumbengegwiMultidisciplinary Research Centre, University of Namibia, Windhoek 13301, Namibia.
Michelle S HsiangMalaria 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.

Funding

Mentoring translational scientists in international infectious disease researchK24AI144048 · NIAID · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Bryan R Greenhouse · 2019 to 2026
$1.6M
NIAID NIH HHS K24 AI144048
6 · The paper itself

Abstract

backgroundThe 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.

methodsWe 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.

findingsAmong 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 = 60), drug resistance did not explain persistent positivity. Younger age (<15 years versus ≥15 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 (≥7 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.

interpretationDuration 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.

fundingThe project was funded by the Bill and Melinda Gates Foundation (A128488 and INV1135840), Horchow Family Fund (5300375400), and Chan Zuckerberg Biohub.

Indexed as

Antigens, ProtozoanDiagnostic Tests, RoutineMalaria, FalciparumPlasmodium falciparumAdolescentAdultAgedAntimalarialsChildChild, PreschoolCohort StudiesFemaleHumansInfantLongitudinal StudiesMaleAntigens, ProtozoanAntimalarialsHRP-2 antigen, Plasmodium falciparumProtozoan ProteinsHistidine-rich proteinLow-endemicLow transmissionMalariaMalaria eliminationPersistence

Identifiers

PMID39657364
PMCPMC11683224

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.