Blood-Based Malaria Testing

Malaria and HIV are among the most pressing public health challenges in Africa, with malaria being the leading cause of morbidity and mortality in the region (World Health Organization, 2020). Blood-based testing for malaria has become increasingly common in Africa, but concerns have arisen about the potential for these tests to inadvertently fuel HIV transmission. This concern is highlighted by recent outbreaks of unknown diseases, such as the one in Marsabit County, Kenya, in May 2023, where the initial diagnosis suggested a form of “violent malaria” (RT News, 2023). This essay will critically assess the evidence linking blood-based malaria testing to increased HIV transmission risk and discuss the potential benefits of shifting towards alternative testing methods, such as saliva and urine-based tests.

Blood-based Malaria Testing and HIV Transmission

The vast majority of malaria cases occur in Africa, with the World Health Organization (WHO) estimating that the continent accounted for approximately 94% of the 229 million malaria cases worldwide in 2019 (World Health Organization, 2020). Blood-based rapid diagnostic tests (RDTs) have been widely adopted for malaria diagnosis, as they are quick, cost-effective, and have a high degree of sensitivity and specificity (World Health Organization, 2020). However, the use of blood-based testing raises concerns about the potential for iatrogenic HIV transmission, particularly in settings with limited resources and infection control measures (Ilesanmi et al., 2020).

Alternative Testing Methods: Saliva and Urine-based Tests

In recent years, researchers have explored the use of saliva and urine-based tests as alternatives to blood-based testing for malaria diagnosis. Nwakanma et al. (2014) demonstrated that Plasmodium falciparum DNA could be detected in saliva and urine samples with high sensitivity and specificity, suggesting that these sample types may be suitable for non-invasive malaria diagnosis. While further validation and optimization of these tests are required, their potential to minimize the risk of bloodborne infection transmission should not be overlooked.

Shifting towards non-invasive testing methods could not only reduce the risk of HIV transmission but also improve access to malaria testing for vulnerable populations, such as children and pregnant women, who may be less likely to consent to blood-based testing due to fear of needles or other concerns (Nwakanma et al., 2014). Moreover, non-invasive tests could facilitate large-scale malaria surveillance efforts, as they are easier to administer and require less stringent biosafety measures than blood-based tests. 

Conclusion

Although blood-based testing for malaria has been instrumental in the fight against the disease, concerns about its potential role in fueling HIV transmission warrant serious consideration. Recent outbreaks, such as the one in Marsabit County, Kenya, where a suspected form of “violent malaria” claimed nine lives and affected over 80 people (RT News, 2023), highlight the need for more accurate and safer diagnostic methods. The development and validation of alternative testing methods, such as saliva and urine-based tests, hold promise for reducing the risk of blood borne infection transmission while maintaining high diagnostic accuracy.

Future Directions

As non-invasive testing methods for malaria continue to be developed and validated, it is crucial for policymakers and healthcare providers to stay informed about the latest advancements and consider their potential implications for public health. One of the main challenges in implementing saliva and urine-based tests is ensuring their sensitivity and specificity are on par with current blood-based testing methods. Ongoing research and development efforts should focus on improving the performance of these alternative tests and addressing any practical barriers to their adoption.

In addition to exploring alternative diagnostic methods, it is essential to strengthen infection prevention and control measures in healthcare settings, particularly in resource-limited environments where the risk of bloodborne infection transmission may be higher. This includes proper training for healthcare workers in safe injection practices, adherence to sterilization protocols, and promoting the use of single-use auto-disable injection devices (Ilesanmi et al., 2020).

Collaboration between governments, non-governmental organizations, and the private sector will be vital in driving the development, validation, and implementation of non-invasive malaria diagnostic tools. By fostering partnerships and investing in innovative solutions, the global health community can help mitigate the risk of HIV transmission associated with blood-based testing and contribute to the ongoing efforts to combat malaria and HIV in Africa.

In conclusion, the development and implementation of alternative, non-invasive malaria testing methods have the potential to reduce the risk of bloodborne infection transmission, including HIV, while maintaining high diagnostic accuracy. By exploring these new diagnostic approaches and investing in infection prevention and control measures, it is possible to address both the malaria and HIV epidemics in a more comprehensive and effective manner, ultimately improving public health outcomes in Africa.

Notes

In 2019, there were an estimated 148 million people in 37 malaria endemic countries who needed assistance due to health and humanitarian emergencies, not including the COVID-19 pandemic. This number increased to 301 million in 2020 and 268 million in 2021 (Map above). Conflicts, famine and flooding were the major contributors to these humanitarian emergencies, sometimes compounded by disease outbreaks. Among the countries with the highest need in 2021 in terms of people affected were Afghanistan, Colombia, the Democratic Republic of the Congo, Ethiopia, Mali, Myanmar, Nigeria, Somalia, South Sudan, the Sudan, Uganda and Yemen. In each of these countries, increases in malaria cases occurred above what could be attributed to the COVID-19 pandemic.

References

1. RT News. (2023). ‘Mysterious’ disease kills nine in Kenya – officials. Retrieved from https://www.rt.com/africa/576130-kenya-mysterious-disease-outbreak/

2. Ilesanmi, O. S., Afolabi, A. A., & Arikawe, A. P. (2020). Improving infection prevention and control in Nigerian hospitals through the use of single-use auto-disable injection devices. Transactions of the Royal Society of Tropical Medicine and Hygiene, 114(6), 404-406.

3. Matee, M. I., Magesa, P. M., & Lyamuya, E. F. Seroprevalence of human immunodeficiency virus, hepatitis B and C viruses, and syphilis infections among blood donors at the Muhimbili National Hospital in Dar es Salaam, Tanzania. BMC Public Health, 6, 21.

4. Nwakanma, D. C., Gomez-Escobar, N., Walther, M., Crozier, S., Dubovsky, F., Malkin, E., Locke, E., & Conway, D. J. (2014). Quantitative detection of Plasmodium falciparum DNA in saliva, blood, and urine. Journal of Infectious Diseases, 209(11), 1821-1826. World Health Organization. (2020). World malaria report 2020: 20 years of global progress and challenges. Retrieved from https://www.who.int/publications/i/item/9789240015791