The Center for Disease Dynamics, Economics & Policy

REGISTRATION BY INVITATION

This consultation will kick off Phase 1 of the Febrile Illness Diagnostics Project.

For decades, people living in malaria-endemic areas have taken malaria drugs for febrile illnesses that might or might not be malaria.  Recent developments have rendered this “presumptive treatment” a less attractive approach, mainly because options that are more efficient and better for patients are available. When treatment for malaria is given without diagnosis, patients suffering from other serious infections—pneumonia, in particular—go untreated and may suffer dire effects. 

The ready availability of rapid diagnostic tests (RDTs) for malaria have made it possible to quickly determine when malaria is not the culprit—and it is not far more often than had been presumed—but the path beyond that is still murky.  A second factor is that artemisinin-combination therapies (ACTs) have supplanted chloroquine and sulfadoxine‐pyrimethamine (SP), the previously relied upon drugs, as the recommended first-line treatment for falciparum malaria.  While ACTs are effective, their increased cost has been a significant drawback.  Expanding the use of RDTs has the added benefit of offsetting the cost of ACTs. 

Currently, RDTs for malaria alone are available, but febrile illness rapid diagnostic tests (FIRDTs) that include malaria antigens among others have the added potential to target the use of ACTs to cases where the malaria parasite is among the responsible pathogens and, where it is not, point to the pathogen responsible. By cutting down on the unnecessary use of antimalarials and antibiotics through better targeting, FIRDTs can slow the spread of drug resistance, a costly consequence of treatment for malaria and pneumonias. For any of this to happen, FIRDTs must reach patients—whether in a public sector facility, private clinic or retail outlet—and ensure that treatment is informed by the result.  Incentives related to financing and consumer prices of antibiotics, antimalarials and RDTs are key. 

The starting point for implementation is a core cost-effectiveness analysis of FIRDTs in children.  This is the main deliverable for Phase 1 of the Febrile Illness Diagnostics Project, involving examining the attractiveness of alternative expansion paths to universal pre-treatment diagnosis, research and development priorities, and resistance to ACTs and antibiotics.  The project will also introduce a framework of models for global financing to ensure FIRDT adoption and adherence.