Modelling the incremental benefit of introducing malaria to antenatal care in Africa

Patrick G.T. Walker; Matt Cairns; Hannah Slater; Julie Gutman; Kassoum Kayentao; John E. Williams; Sheick O. Coulibaly; Carole Khairallah; Steve Taylor; Steven R. Meshnick; Jenny Hill; Victor Mwapasa; Linda Kalilani-Phiri; Kalifa Bojang; Simon Kariuki; Harry Tagbor; Jamie T. Griffin; Mwayi Madanitsa; Azra C.H. Ghani; Meghna Desai; Feiko Ter Kuile

doi:10.1038/s41467-020-17528-3

Modelling the incremental benefit of introducing malaria to antenatal care in Africa

Patrick G.T. Walker, Matt Cairns, Hannah Slater, Julie Gutman, Kassoum Kayentao, John E. Williams, Sheick O. Coulibaly, Carole Khairallah, Steve Taylor, Steven R. Meshnick, Jenny Hill, Victor Mwapasa, Linda Kalilani-Phiri, Kalifa Bojang, Simon Kariuki, Harry Tagbor, Jamie T. Griffin, Mwayi Madanitsa, Azra C.H. Ghani, Meghna DesaiFeiko Ter Kuile

Clinical Sciences

Research output: Contribution to journal › Article › peer-review

21 Citations (Scopus)

Abstract

Plasmodium falciparum in pregnancy is a major cause of adverse pregnancy outcomes. We combine performance estimates of standard rapid diagnostic tests (RDT) from trials of intermittent screening and treatment in pregnancy (ISTp) with modelling to assess whether

screening at antenatal visits improves upon current intermittent preventative therapy with sulphadoxine-pyrimethamine (IPTp-SP). We estimate that RDTs in primigravidae at first antenatal visit are substantially more sensitive than in non-pregnant adults (OR=17.2, 95% Cr.I. 13.8-21.6), and that sensitivity declines in subsequent visits and with gravidity, likely driven by declining susceptibility to placental infection. Monthly ISTp with standard RDTs, even with highly effective drugs, is not superior to monthly IPTp-SP. However, a hybrid strategy, recently adopted in Tanzania, combining testing and treatment at first visit with IPTp-SP may offer benefit, especially in areas with high-grade SP resistance. Screening and treatment in the first trimester, when IPTp-SP is contraindicated, could substantially improve pregnancy outcomes.

Original language	English
Article number	3799
Pages (from-to)	3799
Journal	Nature Communications
Volume	11
Issue number	1
DOIs	https://doi.org/10.1038/s41467-020-17528-3
Publication status	Published - 30 Jul 2020

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10.1038/s41467-020-17528-3Licence: CC BY

Walker et al Malaria testing at ANC acceptedAccepted author manuscript, 382 KBLicence: CC BY
Walker-2020-Modelling-the-incremental-benefit-oFinal published version, 1.01 MBLicence: CC BY

Cite this

Walker, P. G. T., Cairns, M., Slater, H., Gutman, J., Kayentao, K., Williams, J. E., Coulibaly, S. O., Khairallah, C., Taylor, S., Meshnick, S. R., Hill, J., Mwapasa, V., Kalilani-Phiri, L., Bojang, K., Kariuki, S., Tagbor, H., Griffin, J. T., Madanitsa, M., Ghani, A. C. H., ... Ter Kuile, F. (2020). Modelling the incremental benefit of introducing malaria to antenatal care in Africa. Nature Communications, 11(1), 3799. Article 3799. https://doi.org/10.1038/s41467-020-17528-3

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title = "Modelling the incremental benefit of introducing malaria to antenatal care in Africa",

abstract = "Plasmodium falciparum in pregnancy is a major cause of adverse pregnancy outcomes. We combine performance estimates of standard rapid diagnostic tests (RDT) from trials of intermittent screening and treatment in pregnancy (ISTp) with modelling to assess whether screening at antenatal visits improves upon current intermittent preventative therapy with sulphadoxine-pyrimethamine (IPTp-SP). We estimate that RDTs in primigravidae at first antenatal visit are substantially more sensitive than in non-pregnant adults (OR=17.2, 95\% Cr.I. 13.8-21.6), and that sensitivity declines in subsequent visits and with gravidity, likely driven by declining susceptibility to placental infection. Monthly ISTp with standard RDTs, even with highly effective drugs, is not superior to monthly IPTp-SP. However, a hybrid strategy, recently adopted in Tanzania, combining testing and treatment at first visit with IPTp-SP may offer benefit, especially in areas with high-grade SP resistance. Screening and treatment in the first trimester, when IPTp-SP is contraindicated, could substantially improve pregnancy outcomes.",

author = "Walker, \{Patrick G.T.\} and Matt Cairns and Hannah Slater and Julie Gutman and Kassoum Kayentao and Williams, \{John E.\} and Coulibaly, \{Sheick O.\} and Carole Khairallah and Steve Taylor and Meshnick, \{Steven R.\} and Jenny Hill and Victor Mwapasa and Linda Kalilani-Phiri and Kalifa Bojang and Simon Kariuki and Harry Tagbor and Griffin, \{Jamie T.\} and Mwayi Madanitsa and Ghani, \{Azra C.H.\} and Meghna Desai and \{Ter Kuile\}, Feiko",

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Walker, PGT, Cairns, M, Slater, H, Gutman, J, Kayentao, K, Williams, JE, Coulibaly, SO, Khairallah, C, Taylor, S, Meshnick, SR, Hill, J, Mwapasa, V, Kalilani-Phiri, L, Bojang, K, Kariuki, S, Tagbor, H, Griffin, JT, Madanitsa, M, Ghani, ACH, Desai, M & Ter Kuile, F 2020, 'Modelling the incremental benefit of introducing malaria to antenatal care in Africa', Nature Communications, vol. 11, no. 1, 3799, pp. 3799. https://doi.org/10.1038/s41467-020-17528-3

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T1 - Modelling the incremental benefit of introducing malaria to antenatal care in Africa

AU - Walker, Patrick G.T.

AU - Cairns, Matt

AU - Slater, Hannah

AU - Gutman, Julie

AU - Kayentao, Kassoum

AU - Williams, John E.

AU - Coulibaly, Sheick O.

AU - Khairallah, Carole

AU - Taylor, Steve

AU - Meshnick, Steven R.

AU - Hill, Jenny

AU - Mwapasa, Victor

AU - Kalilani-Phiri, Linda

AU - Bojang, Kalifa

AU - Kariuki, Simon

AU - Tagbor, Harry

AU - Griffin, Jamie T.

AU - Madanitsa, Mwayi

AU - Ghani, Azra C.H.

AU - Desai, Meghna

AU - Ter Kuile, Feiko

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Y1 - 2020/7/30

N2 - Plasmodium falciparum in pregnancy is a major cause of adverse pregnancy outcomes. We combine performance estimates of standard rapid diagnostic tests (RDT) from trials of intermittent screening and treatment in pregnancy (ISTp) with modelling to assess whether screening at antenatal visits improves upon current intermittent preventative therapy with sulphadoxine-pyrimethamine (IPTp-SP). We estimate that RDTs in primigravidae at first antenatal visit are substantially more sensitive than in non-pregnant adults (OR=17.2, 95% Cr.I. 13.8-21.6), and that sensitivity declines in subsequent visits and with gravidity, likely driven by declining susceptibility to placental infection. Monthly ISTp with standard RDTs, even with highly effective drugs, is not superior to monthly IPTp-SP. However, a hybrid strategy, recently adopted in Tanzania, combining testing and treatment at first visit with IPTp-SP may offer benefit, especially in areas with high-grade SP resistance. Screening and treatment in the first trimester, when IPTp-SP is contraindicated, could substantially improve pregnancy outcomes.

AB - Plasmodium falciparum in pregnancy is a major cause of adverse pregnancy outcomes. We combine performance estimates of standard rapid diagnostic tests (RDT) from trials of intermittent screening and treatment in pregnancy (ISTp) with modelling to assess whether screening at antenatal visits improves upon current intermittent preventative therapy with sulphadoxine-pyrimethamine (IPTp-SP). We estimate that RDTs in primigravidae at first antenatal visit are substantially more sensitive than in non-pregnant adults (OR=17.2, 95% Cr.I. 13.8-21.6), and that sensitivity declines in subsequent visits and with gravidity, likely driven by declining susceptibility to placental infection. Monthly ISTp with standard RDTs, even with highly effective drugs, is not superior to monthly IPTp-SP. However, a hybrid strategy, recently adopted in Tanzania, combining testing and treatment at first visit with IPTp-SP may offer benefit, especially in areas with high-grade SP resistance. Screening and treatment in the first trimester, when IPTp-SP is contraindicated, could substantially improve pregnancy outcomes.

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DO - 10.1038/s41467-020-17528-3

M3 - Article

SN - 2041-1723

VL - 11

SP - 3799

JO - Nature Communications

JF - Nature Communications

IS - 1

M1 - 3799

ER -

Modelling the incremental benefit of introducing malaria to antenatal care in Africa

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