Cost-effectiveness and ease of test performance of Direct Agglutination Test and the rK39 rapid diagnostic test for visceral leishmaniasis in Wajir county, Kenya

Abstract

Background: Testing for Visceral Leishmaniasis (VL)or Kala-Azar (KA) in low resource areas like Wajir was predominantly by serological tests like the Direct Agglutination Test (DAT) and the rapid diagnostic test (rK39). DAT was difficult to use in Wajir because it required unavailable specialized laboratories. Also, the Kenyan Ministry of Health (MOH) during part of this period did not recognize rK39 as a baseline test whereas it is available in Wajir. This resulted in systemic confusion in testing.
Objective: To determine the cost-effectiveness and ease of performance of DAT and rK39 which were randomly used to test for KA in Wajir.
Methods: Analytical study of laboratory records of newly tested patients by way of desk review was done. Quota sampling yielded 65 for study. The clinical decision analysis and diagnostic odds ratio were used for analysis.
Setting and Study Subjects: The study was done on the Wajir County Hospital records of the year 2008-18 of patients newly tested by DAT, rK39 and splenic aspiration.
Outcome measures: Cost-Effectiveness Ratio (CER) and ease of test performance of the DAT and rK39 tests.
Results: The study found a lower average CER of rK39 (57) compared to DAT (812) equivalent to ratio of 0.07:1. It also found performing rK39 required fewer and simpler resources than DAT.
Conclusions and Recommendations: The findings correlated well with similar studies done in other KA endemic areas. It was recommended that the rK39 test be adopted as the first-line diagnostic test for KA in Wajir and similar settings