Field deployment of loop-mediated isothermal amplification for centralized mass-screening of asymptomatic XXXX in Zanzibar: a pre-elimination setting.

@entity1 @entity311 @entity1062 @entity3964
BACKGROUND: Molecular tools for detection of low-density asymptomatic @entity3964 infections are needed in @entity311 elimination efforts. This study reports results from the hitherto largest implementation of loop-mediated isothermal amplification (LAMP) for centralized mass screening of asymptomatic @entity311 in Zanzibar. METHODS: Healthy individuals present and willing to participate in randomly selected households in 60 villages throughout Zanzibar were screened for @entity311 by @entity1062 ( @entity1062 ). In 50% of the study households, @entity1 were asked to provide 60  L of finger-prick blood for additional LAMP screening. LAMP was conducted in two centralized laboratories in Zanzibar, by trained technicians with limited or no previous experience of molecular methods. The LAMP assay was performed with Loopamp(TM) MALARIA Pan/Pf Detection Kit (Eiken Chemical Company, Japan). Samples positive for @entity3964 genus (Pan)-LAMP were re-tested using @entity3964 -specific LAMP kits. RESULTS: Paired @entity1062 and LAMP samples were available from 3983 individuals. The prevalence of asymptomatic @entity311 was 0.5% (CI 95% 0.1-0.8) and 1.6% (CI 95% 1.1-2.2) by @entity1062 and Pan-LAMP, respectively. LAMP detected 3.4 (CI 95% 2.2-5.2) times more @entity3964 positive samples than @entity1062 . DNA contamination was experienced, but solved by repetitive decontamination of all equipment and reagents. CONCLUSIONS: LAMP is a simple and sensitive molecular tool, and has potential in active surveillance and mass-screening programmes for detection of low-density asymptomatic @entity311 in pre-elimination settings. However, in order to deploy LAMP more effectively in field settings, protocols may need to be adapted for processing larger numbers of samples. A higher throughput, affordable closed system would be ideal to avoid contamination.
