Table 2.

Analysis of test type for a combination HS-RDT to support ACD

Test type	Interpretation and treatment	Advantages	Disadvantages	Comments
Pan/Pf/Pv	Pan(+)/Pf(+)/Pv(+) → ACT + PQ Pan(+)/Pf(+)/Pv(−) → ACT Pan(+)/Pf(−)/Pv(+) → CQ + PQ Pan(+)/Pf(−)/Pv(−) → CQ	Detects all species Differentiates Pf Allows targeted Pv radical cure	Does not target Po radical cure	Helpful for surveillance in drug resistant areas because differentiates Pf Difficult interpretation by end user Technically challenging
Pan/Pf	Pan(+)/Pf(+) → ACT Pan(+)/Pf(−) → CQ(+PQ)	Detects all species Differentiates Pf	Pan(+)/Pf(+) could be a mixed infection requiring PQ Pan(+)/Pf(−) would not receive PQ if Pv not confirmed	Helpful for surveillance in drug resistant areas because differentiates Pf 29% of current RDT volume market Common, familiar format
Pf/Pv	Pf(+)/Pv(+) → ACT + PQ Pf(+)/Pv(−) → ACT Pf(−)/Pv(+) → CQ + PQ	Differentiates Pf Allows targeted Pv radical cure	Does not detect Pm/Po/Pk Does not target Po radical cure	Helpful for surveillance in drug resistant areas because differentiates Pf 6% of current RDT volume market
Pf/Pvom	Pf(+)/Pvom(+) → ACT + PQ Pf(+)/Pvom(−) → ACT Pf(−)/Pvom(+) → CQ + PQ	Differentiates Pf Allows targeted Pv and Po radical cure	Over-treatment of Pm with PQ Does not detect Pk	Helpful for surveillance in drug resistant areas because differentiates Pf Commercial product available
Pan/Pvo	Pan(+)/Pvo(+) → ACT + PQ Pan(+)/Pvo(−) → ACT	Detects all species Allows targeted Pv and Po radical cure	Does not differentiate Pf	Shift from CQ to ACT for non-falciparum Limited surveillance data on species; speciation at reference lab required
Pan only	Pan(+) → ACT + PQ	Detects all species	Over-treatment of Pf/Pm/Pk with PQ Does not differentiate Pf	Shift from CQ to ACT for non-falciparum Limited surveillance data on species; speciation at reference lab required

This analysis assumes that all test lines have the same limit of detection required to detect sub-microscopic infections and that glucose-6-phosphate dehydrogenase (G6PD) deficiency testing is available and done when required

HS-RDT (high sensitive rapid diagnostic test); ACD (Active Case Detection); Pan (all Plasmodium species); Pf (Plasmodium falciparum); Pv (P. vivax); Pvom (P. vivax, P. ovale, and P. malariae); Pvo (P. vivax and P. ovale); Pk (P. knowlesi); ACT (artemisinin-combination therapy); PQ (primaquine); CQ (chloroquine); NAATs (nucleic acid amplification techniques)