A mixed methods study assessing the adoption potential of a saliva-based malaria rapid test in the Democratic Republic of Congo

BackgroundThe reliance on blood for thin and thick blood smear microscopy-using a relatively invasive procedure has presented challenges to the use of reliable diagnostic tests in non-clinical settings at the point-of-need (PON). To improve the capacity of non-blood-based rapid diagnostic tests to confirm subclinical infections, and thereby identify and quantify the human reservoir at the PON, a cross-sectoral collaboration between university researchers and commercial partners produced an innovative, non-invasive saliva-based RDT capable of identifying novel, non-hrp2/3 parasite biomarkers. While this new saliva-based malaria asymptomatic and asexual rapid test (SMAART-1) shows increased detection sensitivity and precision potential by identifying a new P. falciparum protein marker (PSSP17), appraising its utility in the field-particularly with respect to its adoption potential with children and adults in high risk, endemic regions-is necessary to warrant its continued development.MethodsThe purpose of this study was to assess the acceptability and adoption potential of the SMAART-1 at select PON sites in the Kinshasa Province. Teachers, community health workers, nurses, and laboratory technicians participated in data collection at three distinct community sites in Kinshasa Province, Democratic Republic of the Congo. Three data collection methods were utilized in this mixed methods study to provide an overarching acceptability evaluation of the SMAART-1 at PON field sites: observation checklists of SMAART-1 implementation, focus group discussions, and surveys with local health care practitioners-particularly teachers and community health workers.ResultsFindings indicate participants were interested in and supportive of the SMAART-1 protocol, with approximately 99% of the participants surveyed indicating that they either agreed or strongly agreed with the statement that they would use the saliva-based malaria asymptomatic rapid test as part of a community malaria detection and treatment programme. Data also suggest that the protocol was broadly appealing for its testing sensitivity and ease of use.ConclusionsThe SMAART-1 protocol's clinically reliable results demonstrate a promising new level of sensitivity and precision for detecting parasite biomarkers. This study's mixed-methods assessment of the protocol's utility and adoption potential in the field, with a target user audience, advances its development and points to opportunities to formalize and expand evaluation efforts.

Automated summary

A cross-sectoral collaboration developed a new non-invasive saliva-based rapid diagnostic test that can confirm subclinical infections without the need for blood samples. The acceptability and adoption potential of this test were assessed in Kinshasa Province, and the results showed that participants were interested in and supportive of the test due to its sensitivity and ease of use. Overall, this saliva-based rapid test shows promise in the field and has a high potential for application.