Fever among HIV-Positive Adults in Rural Rakai, Uganda

Utility of a Point-of-Care Malaria Rapid Diagnostic Test for Excluding Malaria as the Cause of Fever among HIV-Positive Adults in Rural Rakai, Uganda.

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Mills and colleagues compared results of a malaria rapid diagnostic test (Binax Now ® Malaria, Binax-M, Inverness Medical Innovations, Inc., Waltham, MA) performed at rural mobile clinics in Uganda by clinicians evaluating febrile adult HIV patients to thick smear evaluated at a central laboratory by trained microscopists. Two hundred forty-six samples were analyzed, including 14 (5.7%) which were thick-smear positive for falciparum malaria. Sensitivity of Binax-M compared with thick smear was 85.7% (95% CI: 57.2–98.2), specificity 97.8% (95% CI: 94.9–99.3), positive and negative predictive values were 70.6% (95% CI: 44.0–89.7) and 99.1% (95% CI: 96.8–99.9), respectively. The rapid diagnostic test accurately ruled malaria "in or out" at the point-of-care, facilitating appropriate clinical management and averting unnecessary anti-malarial therapy.

Through a PEPFAR-funded mobile HIV clinic programme, most participants in this study in a falciparum malaria endemic district in Uganda had received insecticide treated bed nets, cotrimoxasole prophylaxis regardless of CD4 count, and antiretroviral treatment if their CD4 counts fell below 250 cells/ µ l. With malaria suspected in 41.5% of general out-patient visits in this district, use of this point-of-care test in people living with HIV who presented with fever allowed health care providers to focus on other urgent causes of fever. The test had a high negative predictive value, meaning that a negative test was highly likely to mean that the person did not have malaria.