Performance of the Access Bio/CareStart rapid diagnostic test for the detection of glucose-6-phosphate dehydrogenase deficiency: A systematic review and meta-analysis

Autoři: Benedikt Ley aff001;  Ari Winasti Satyagraha aff002;  Hisni Rahmat aff002;  Michael E. von Fricken aff003;  Nicholas M. Douglas aff001;  Daniel A. Pfeffer aff001;  Fe Espino aff004;  Lorenz von Seidlein aff005;  Gisela Henriques aff007;  Nwe Nwe Oo aff008;  Didier Menard aff009;  Sunil Parikh aff010;  Germana Bancone aff006;  Amalia Karahalios aff012;  Ric N. Price aff001
Působiště autorů: Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia aff001;  Eijkman Institute for Molecular Biology, Jakarta, Indonesia aff002;  Department of Global and Community Health, George Mason University, Fairfax, Virginia, United States of America aff003;  Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Philippines aff004;  Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand aff005;  Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom aff006;  Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom aff007;  Department of Medical Research (Lower Myanmar), Yangon, Republic of the Union of Myanmar aff008;  Malaria Genetics and Resistance Unit, Institut Pasteur, Paris, France aff009;  Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America aff010;  Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand aff011;  Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia aff012
Vyšlo v časopise: Performance of the Access Bio/CareStart rapid diagnostic test for the detection of glucose-6-phosphate dehydrogenase deficiency: A systematic review and meta-analysis. PLoS Med 16(12): e1002992. doi:10.1371/journal.pmed.1002992
Kategorie: Research Article
doi: 10.1371/journal.pmed.1002992



To reduce the risk of drug-induced haemolysis, all patients should be tested for glucose-6-phosphate dehydrogenase (G6PD) deficiency (G6PDd) prior to prescribing primaquine (PQ)-based radical cure for the treatment of vivax malaria. This systematic review and individual patient meta-analysis assessed the utility of a qualitative lateral flow assay from Access Bio/CareStart (Somerset, NJ) (CareStart Screening test for G6PD deficiency) for the diagnosis of G6PDd compared to the gold standard spectrophotometry (International Prospective Register of Systematic Reviews [PROSPERO]: CRD42019110994).

Methods and findings

Articles published on PubMed between 1 January 2011 and 27 September 2019 were screened. Articles reporting performance of the standard CSG from venous or capillary blood samples collected prospectively and considering spectrophotometry as gold standard (using kits from Trinity Biotech PLC, Wicklow, Ireland) were included. Authors of articles fulfilling the inclusion criteria were contacted to contribute anonymized individual data. Minimal data requested were sex of the participant, CSG result, spectrophotometry result in U/gHb, and haemoglobin (Hb) reading. The adjusted male median (AMM) was calculated per site and defined as 100% G6PD activity. G6PDd was defined as an enzyme activity of less than 30%. Pooled estimates for sensitivity and specificity, unconditional negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR−) were calculated comparing CSG results to spectrophotometry using a random-effects bivariate model.

Of 11 eligible published articles, individual data were available from 8 studies, 6 from Southeast Asia, 1 from Africa, and 1 from the Americas. A total of 5,815 individual participant data (IPD) were available, of which 5,777 results (99.3%) were considered for analysis, including data from 3,095 (53.6%) females. Overall, the CSG had a pooled sensitivity of 0.96 (95% CI 0.90–0.99) and a specificity of 0.95 (95% CI 0.92–0.96). When the prevalence of G6PDd was varied from 5% to 30%, the unconditional NPV was 0.99 (95% CI 0.94–1.00), with an LR+ and an LR− of 18.23 (95% CI 13.04–25.48) and 0.05 (95% CI 0.02–0.12), respectively.

Performance was significantly better in males compared to females (p = 0.027) but did not differ significantly between samples collected from capillary or venous blood (p = 0.547). Limitations of the study include the lack of wide geographical representation of the included data and that the CSG results were generated under research conditions, and therefore may not reflect performance in routine settings.


The CSG performed well at the 30% threshold. Its high NPV suggests that the test is suitable to guide PQ treatment, and the high LR+ and low LR− render the test suitable to confirm and exclude G6PDd. Further operational studies are needed to confirm the utility of the test in remote endemic settings.

Klíčová slova:

Blood – Blood counts – Capillaries – Glucose-6-phosphate dehydrogenase deficiency – Malaria – Spectrophotometry – Systematic reviews


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