MOESM1 of Implementation strategies to increase access and demand of long-lasting insecticidal nets: a before-and-after study and scale-up process in Mozambique

Additional file 1: Appendix 1. Micro-planning tool

Role and perceived impact of CAG members at the different levels of ART care.

<p>Role and perceived impact of CAG members at the different levels of ART care.</p

Quotes of key informants illustrating the major findings.

<p>Quotes of key informants illustrating the major findings.</p

Participants of the focus group discussions and in depth interviews.

<p>CAG – Community ART groups; IDI – In depth interviews; FGD – Focus group discussions.</p>§<p>Patients in CAG were divided in three groups according to their geographical residence and the distance to the clinics: (1) remote areas – patients who have to travel long distances to access care with major transport problems, (2) rural areas –patients who can reach healthcare services by foot or bicycle and (3) semi-urban areas – patients who live close to main road with access to public transport.</p><p><b>*</b> To ensure a fluent implementation of the CAG model and monitoring of the groups, MSF appointed counsellors to the large health facilities, taking a major role in the daily management of the CAG activities. Whereas in smaller health facilities, MoH nurses are responsible for all these activities. For the interviews nurses have been divided into two groups: (1) nurses working with counsellors and (2) nurses working without counsellors.</p

The Community ART Groups model.

<p>The Community ART Groups model.</p

Summary of the six themes identified based on the content of the interviews.

<p>CAG – Community ART Groups.</p

Additional file 1 of Multiple Anopheles species complicate downstream analysis and decision-making in a malaria pre-elimination area in southern Mozambique

Additional file 1. Sequence data

HRP2 bead assay only detects HRP2-producing <i>P</i>. <i>falciparum</i>.

<p>Plasma from non-infected persons, or persons with symptomatic <i>Plasmodium</i> spp. infection was assayed at a 1:10x dilution for presence of HRP2. <b>P. mal</b>: <i>P</i>. <i>malariae</i>; <b>P. ova</b>: <i>P</i>. <i>ovale</i>.</p

Test comparison between bead assay and HRP2 RDTs.

<p>(<b>A</b>) Persons from Mozambique tested for presence of HRP2 by RDT (SD Bioline Pf) and bead assay, and comparison statistics for the two tests. For this purpose, the RDT was treated as the standard classification predictor and the bead assay as the novel test. The same analysis in (<b>B</b>) for persons from Angola where the SD Bioline Malaria Ag P.f/P.v RDT was used and in (<b>C</b>) Haiti where the First Response HRP2 RDT was used.</p

Bead-based immunoassay allows sub-picogram detection of histidine-rich protein 2 from <i>Plasmodium falciparum</i> and estimates reliability of malaria rapid diagnostic tests

<div><p>Detection of histidine-rich protein 2 (HRP2) from the malaria parasite <i>Plasmodium falciparum</i> provides evidence for active or recent infection, and is utilized for both diagnostic and surveillance purposes, but current laboratory immunoassays for HRP2 are hindered by low sensitivities and high costs. Here we present a new HRP2 immunoassay based on antigen capture through a bead-based system capable of detecting HRP2 at sub-picogram levels. The assay is highly specific and cost-effective, allowing fast processing and screening of large numbers of samples. We utilized the assay to assess results of HRP2-based rapid diagnostic tests (RDTs) in different <i>P</i>. <i>falciparum</i> transmission settings, generating estimates for true performance in the field. Through this method of external validation, HRP2 RDTs were found to perform well in the high-endemic areas of Mozambique and Angola with 86.4% and 73.9% of persons with HRP2 in their blood testing positive by RDTs, respectively, and false-positive rates of 4.3% and 0.5%. However, in the low-endemic setting of Haiti, only 14.5% of persons found to be HRP2 positive by the bead assay were RDT positive. Additionally, 62.5% of Haitians showing a positive RDT test had no detectable HRP2 by the bead assay, likely indicating that these were false positive tests. In addition to RDT validation, HRP2 biomass was assessed for the populations in these different settings, and may provide an additional metric by which to estimate <i>P</i>. <i>falciparum</i> transmission intensity and measure the impact of interventions.</p></div