Malaria remains one of the most devastating infectious diseases in the world. Despite the potential for serious adverse outcomes with each episode of malaria, most cases in endemic areas are diagnosed on clinical grounds alone. The presumptive diagnosis of malaria is becoming even more problematic as empiric therapy with safe and inexpensive drugs gives way to newer agents that offer improved efficacy, but the drugs are also more expensive and have unproven safety records. Even the simple technique of light microscopy, the gold standard for malaria diagnosis, is inaccessible to most individuals in resource-poor malarious areas. New malaria diagnostic methods that are practical for limited health-care settings are urgently needed. The proposed research will evaluate immunochromatographic rapid diagnostic tests (RDTs) for malaria in Uganda, with specific aims as follows:

1) to evaluate the performance of RDTs in an on-going longitudinal cohort of children;

2) to evaluate the performance of RDTs cross-sectionally at established surveillance sites of varied malaria endemicity around Uganda; and

3) to assess the cost-effectiveness of using RDTs to diagnose malaria and guide treatment decision-making in Uganda.

Ultimately, results from this study will provide evidence to support or discourage wider implementation of malaria RDTs in sub-Saharan Africa. The candidate, Dr Heidi Hopkins, is an infectious diseases specialist with a strong commitment to malaria research and international health. The career development plan detailed in this proposal will integrate her prior experiences with new expertise in the design and conduct of clinical research studies, laboratory techniques, and economic analysis of health-care interventions. The training environment provided at the University of California, San Francisco, the strong collaboration with Makerere University and the Ugandan Ministry of Health, and economic mentorship from experts at the London School of Hygiene & Tropical Medicine afford the candidate an ideal opportunity to pursue her career development plan.