RAPDIF: a rapid diagnostic test for non-malaria fevers

Due to declining malaria incidence, there is a pressing need to develop innovative diagnostics that can discriminate between malaria and other fever-causing pathogens to ensure appropriate prescription of antibiotics and thereby reducing risk of unnecessary death and generation of drug-resistance. Molecular diagnostics have advantages over traditional diagnostic tools in terms of sensitivity and specificity, but their application as near point-of-care test is limited due to technical requirements. This proposal aims to identify the major causes of febrile illnesses at primary health facility level. Furthermore, it is focused to develop a Molecular Diagnostic test in a (near) Point of Care test that differentiates between non-malaria causes of fever and to evaluate this platform in an endemic setting where both malaria and other febrile illnesses are prevalent. In addition, the project assess current practices in fever management, identifies both at primary and referral health facility level, of potential bottlenecks for the implementation of such a molecular diagnostic platform and estimates the impact of introducing the technology on antibiotics prescription. The work will be focused on the Nanoro health district of Burkina Faso where both malaria and other undifferentiated febrile illnesses are a major contributor to (child) mortality and morbidly. The work is divided into 3 stages of which the first stage has 2 components that run in parallel: 1A) identification of major pathogens causing uncomplicated febrile illnesses at primary health facility levels in Burkina Faso and identifications of disease causing agents present in children referred or admitted to the referral hospital in Nanoro (severe disease); 1B) diagnostic test development at KIT. In stage 2, the developed platform will be validated following standard diagnostic test evaluation criteria of diagnostic phase 1, 2 and 3 testing in the laboratory and the field. Finally, the last stage of the project will focus on the implementation of the diagnostic platform in the routine procedures in Nanoro and measure its effect on patient management and rational use of antibiotics. This project will deliver much needed information on the aetiology of febrile illness in Burkina Faso (Nanoro) and evidence for clinical management and treatment practices in primary health settings. In addition, the diagnostic tool will aid health staff to make better diagnostic, treatment and case management decisions. Capacity building, including training of local health staff, upgrading diagnostic facilities and having a Burkinabe PhD student working on the project, and dissemination activities are an integrated part of the proposed work. Dissemination activities included targeted workshops, presentations at scientific conferences and scientific publications in peer-reviewed international journals (preferably open access). The work will strengthens the ongoing collaboration between project partners and emphasizes the position of the Burkinabe partner as a strong regional research institute. Furthermore, the Burkinabe Institute is directly linked to the Ministry of Health ensuring that the proposed research is, and will remain, in line with National and International (World Health Organisation, Roll Back Malaria Partnership) fever management policies. Importantly, WHO – TDR is directly involved in the project because of their significant interest in management of undifferentiated fevers.