Feasibility of a rapid dipstick antigen-capture assay for self-testing of travellers' malaria

This open comparative study sought to determine whether, and with what leve l of instruction, travellers san successfully use and interpret the rapid w hole blood malaria diagnostic test, ParaSight F. 160 visitors to the Zurich University Travel Clinic took part in the study. One group received writte n instructions only, while another group was given combined oral and writte n instructions on how to tot their own blood for malaria infection and inte rpret a series of 5 prepared test strips. Each volunteer also completed a q uestionnaire targeted at assessing performance in using the diagnostic, int erpretation of the results and acceptability of the concept of self-testing . for malaria infection. The main outcome measures were successful performa nce of the rest, correct interpretation. of prepared test strips and accept ability of the rest. In the group which received only written instructions. 60/80 (75%) were successful, whilst in the group which received written an d oral instructions, 72/80 (90%) successfully performed the test (P < 0.02) . Overall, 56S (70.6%) test strips were correctly and 165 (20.6%) incorrect ly interpreted with 113 (14.1%) false negative interpretations. No prepared test strip was interpreted as false positive. Seventy (8.8%) test strips w ere not interpreted, Some 91.9% of all candidates would use such a test if it were available. While it is possible for lay persons to successfully per form the rest, interpretation of results poses a problem. In particular, th e proportion of false negative interpretations is unacceptable. A combinati on of written and oral instructions leads to 3 significantly higher level o f successful test performance. If such a rest is to be made available to th e general public, written instructions must be made concise and foolproof a nd the test endpoint clearly defined, as the currently available test is mo re suitable for trained laboratory personnel. In the meantime oilier candid ate diagnostics have become available and these should now be assessed for their suitability in the context of travellers' malaria.