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CompletedNCT00935688Updated Feb 7, 2014

Examination of ACT Implementation in a Vivax / Falciparum Co-endemic Area

A Phase 4 interventional study of Rapid diagnostic test in Malaria and Fever, sponsored by London School of Hygiene and Tropical Medicine. Completed at 2 sites in Afghanistan. Per ClinicalTrials.gov, last updated 2014-02-07.

Sponsored by London School of Hygiene and Tropical Medicine · Phase 4, Interventional, and Diagnostic

Phase
Phase 4
Study type
Interventional
Enrollment
4,200
Allocation
Randomized
Sex
All
01

Study summary

In areas of which are co-endemic for vivax and falciparum malaria, treatments for the two diseases often differ and this may lead to mistreatment. This places an emphasis on diagnosis at the health service provision level. Diagnosis is also important when malaris endemicity is low - most fevers are not caused by disease. These two issues mean that most malaria and fevers are not adequately treated, even though the drugs may be effective; many patients who do not have malaria are treated for the disease, and patients with malaria may get the wrong treatment for their species. The study aims to test the effectiveness of employing rapid diagnostic tests and will study the effect on correct treatment.

Read the detailed description

The study will randomly assign diagnostic methods, either with clinical diagnosis, field microscopy or rapid diagnostic tests. The study will take place in 22 clinics in Eastern and Northern Afghanistan, both areas with low transmission of predominantly vivax malaria. They differ in their locations and their current standard diagnostic methods.

The study will examine the result of the diagnostic test in the clinic against the result of reference slides and PCR to estimate the number of cases correctly treated in each arm. This will be a measure of the effectiveness of diagnosis (and the physicians response to the diagnosis) and be influential in considering modalities for diagnostic delivery

02

Conditions studied

  • Malaria
  • Fever

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Keywords

  • malaria
  • rapid diagnostic tests
  • afghanistan
  • Non-specific fever
03

Who can participate

Ages eligible
Child (0–17), Adult (18–64), Older adult (65+)
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Any patient where the clinician* considers malaria in the diagnosis - either prescribing an antimalarial or would request a malaria test if available or referring for diagnosis of malaria elsewhere.
  • Patient, or parent/guardian, gives informed consent to the study.

Exclusion criteria

Exclusion Criteria:

  • Patients with a result from another facility
  • Patients referred on for diagnosis in the private sector
  • Patients the clinician decides to treat presumptively without requesting a test (defined as treating prior to randomisation)
  • Where the clinician requests microscopy specifically due to clinical need prior to randomisation will not be randomised in the trial, but will be noted as part of the study and a reference slide and clinical information will be taken following consent.
04

Study design

Phase
Phase 4
Primary purpose
Diagnostic
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Outcomes assessor)
Enrollment
4,200 participants (actual)

Study arms

  • Experimental
    Rapid diagnostic tests

    malaria diagnosis by rapid diagnostic test

    Other: Rapid diagnostic test

  • No intervention
    Clinic Microscopy

    malaria diagnosed with field light-microscopy

  • No intervention
    Clinical Diagnosis

    Malaria diagnosed on the basis of clinical symptoms alone (i.e. not laboratory diagnosis)

Interventions

  • OtherRapid diagnostic test

    Dual species test for P. vivax and P. falciparum malaria

05

What researchers measure

Primary outcomes

  1. Proportion of patients correctly treated

    Composite measure defined as patients with Pf malaria receiving ACT Drugs; Pv malaria receiving CQ; patients with no malaria receiving no antimalarial drugs. NOTE: Previously reported here as "Proportion of patients incorrectly treated" being 1 minus the Proportion correctly treated. No change in how the outcome was measured.

    Time frame: 2009-2010

Secondary outcomes

  1. % of PV patients not receiving CQ % of PF patients not receiving SP/AS

    Time frame: 2009-2010

  2. Diagnostic Accuracy of the different malaria tests

    Sensitivity and specificity of mRDTs, Microscopy and clinical diagnosis.

    Time frame: 2009-2010

06

Study locations

2 sites
  • HealthNet TPO
    Jalalabad, Nangahar, Afghanistan
  • Merlin
    Kunduz, Afghanistan
07

References and documents

Publications

  • Hansen KS, Grieve E, Mikhail A, Mayan I, Mohammed N, Anwar M, Baktash SH, Drake TL, Whitty CJ, Rowland MW, Leslie TJ. Cost-effectiveness of malaria diagnosis using rapid diagnostic tests compared to microscopy or clinical symptoms alone in Afghanistan. Malar J. 2015 May 28;14:217. doi: 10.1186/s12936-015-0696-1. PubMed 26016871 ↗
  • Leslie T, Mikhail A, Mayan I, Cundill B, Anwar M, Bakhtash SH, Mohammed N, Rahman H, Zekria R, Whitty CJ, Rowland M. Rapid diagnostic tests to improve treatment of malaria and other febrile illnesses: patient randomised effectiveness trial in primary care clinics in Afghanistan. BMJ. 2014 Jun 19;348:g3730. doi: 10.1136/bmj.g3730. PubMed 24948695 ↗
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Registry details

Key details

Study ID
NCT00935688
Lead sponsor
London School of Hygiene and Tropical Medicine
Collaborators
Health Protection and Research Organisation, HealthNet TPO, Medical Emergency Relief International (Merlin)
Responsible party
Mark Rowland (Principle Investigator, Professor of Entomology and Malaria Control, London School of Hygiene and Tropical Medicine) — Principal investigator
First posted
Jul 9, 2009
Start date
May 2009
Primary completion
Oct 2010
Completion
Oct 2010
Last update
Feb 7, 2014

Study contacts

Toby Leslie, PhD
principal investigator · London School of Hygiene and Tropical Medicine

Oversight

Data monitoring committee
Yes
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is completed, as verified in Feb 2014. You cannot join it, but the record below documents what was studied.

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