Feasibility of self‑testing for acute malaria using rapid diagnostic in three peri‑urban sub‑Saharan African community settings

Malaria is a significant cause of under-five child mortality in sub-Saharan Africa (SSA). The World Health Organization (WHO)-approved rapid diagnostic tests (RDT) for malaria offer a resource-efficient alternative to gold standard diagnostic methods and may improve timely access to care through self-testing. The feasibility of use of RDT for self-testing was evaluated in 100 households each in Migori County, Kenya; KwaZulu-Natal Province, South Africa; and Copperbelt Province, Zambia. Surveys assessed perceived usability, acceptability, and preferences for RDTs among consenting participants. Among 225 participants in Kenya, 80 in South Africa, and 163 in Zambia, 25 (11.5%), 0 (0.0%), and 3 (1.8%) tested positive for malaria, respectively. In Kenya and Zambia, 89% of participants reported previous malaria diagnoses. Participants across all three sites interpreted the RDT with 100% sensitivity and 99.7% specificity compared to RDT interpretation performed by a trained study team member, with only one individual interpreting their test incorrectly. Over 96% of participants across all three sites felt the RDT would be easy to use for specimen collection, test operation, and result interpretation, and 160 (100%) Kenyan participants, 74 (96.1%) South African participants, and 157 (99.4%) Zambian participants felt confident that they had interpreted their own test correctly. Participants’ perceived comfort for future self-testing with an RDT was high in Kenya (92%) and Zambia (86%), and moderate in South Africa (66%). These findings indicate that RDT self-testing is highly acceptable and feasible in SSA settings with a high malaria burden.