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—may go untreated and suffer dire effects.

The 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, they cost at least ten times as much as the older drugs. 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) for that identify other conditions 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. But FIRDTs must reach patients—whether in a public sector facility, private clinic or retail outlet—and treatment must be informed by the result for these benefits to be realized. Subsidies and the right pricing of antibiotics, antimalarials and RDTs to consumers are key.

This project of the Centers for Disease Dynamics, Economics & Policy (CDDEP) will explore febrile illness management in the short term, when only malaria RDTs are available; in the medium and long term, as RDTs for other febrile conditions become available; and more generally, the ways in which RDTs can be used within and outside of healthcare systems. The project will also introduce a framework of models for global financing to enhance FIRDT adoption and decisionmaking based on results.