Abstract:
Background: The diagnosis of malaria, using microscopy or rapid diagnostic tests (RDTs), requires the collection of
capillary blood. This procedure is relatively simple to perform but invasive and poses potential risks to patients and
health workers, arising from the manipulation of potentially infectious bodily fluids. Less or non-invasive diagnostic
tests, based on urine, saliva or requiring no sampling, have the potential to generate less discomfort for the patient
and to offer simpler and less risky testing procedures that could be safely performed by untrained staff or even selfperformed.
To explore the potential acceptance and perceived value of such non-invasive tests, an online, international
survey was conducted to gather feedback from National Malaria Control Programme (NMCP) representatives.
Methods: An online survey comprising nineteen questions, available in English, French or Spanish, was emailed to
300 individuals who work with NMCPs in malaria-endemic countries. Answers were collected between November
and December 2017; responses were qualitatively analysed to identify key themes and trends and quantitatively analysed
to determine average values stratified by region.
Results: Responses were received from 70 individuals, from 33 countries. Approximately half of the respondents
(52 %) considered current blood-based tests for malaria to be minimally invasive and non-problematic in their setting.
For these participants, non-invasive tests would only be of interest if they brought additional performance improvements,
as compared with the performance of microscopy and RDTs. Most respondents were of the view that salivabased
(80 %) and urine-based (66 %) tests would be more readily acceptable among children than blood-based tests.
Potential use-case scenarios of interest for both saliva- and urine-based tests were ease-of-testing by community
health workers, additional surveillance, self-testing, and outbreak investigation. Many respondents (41 %) thought
that if saliva-based tests retailed at <$0.50 per unit they could largely replace conventional RDTs, whereas only 25 % of
respondents thought a similarly priced urine-based test would do so.
Conclusions: Although limited to NMCP stakeholders, this survey indicated that current tests for malaria, based on
capillary blood, are generally perceived to be minimally invasive and non-problematic. Non-invasive tests, especially
if saliva-based, would be welcome if they could match or out-perform the price and performance of current bloodbased
tests.
