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The samples were collected as part of a transmission-blocking vaccine trial in a high transmission region for <jats:italic>Plasmodium falciparum<\/jats:italic> malaria. Furthermore, antigen dynamics after successful anti-malarial drug treatment were evaluated in these samples using the Q-Plex Human Malaria Array (4-Plex) to quantify antigen concentrations.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The uRDT had a 50% probability of a positive result at 207\u00a0pg\/mL HRP2 [95% credible interval (CrI) 160\u2013268]. Individuals with symptomatic infection remained positive by uRDT for a median of 33\u00a0days [95% confidence interval (CI) 28\u201347] post anti-malarial drug treatment. Biphasic exponential decay models accurately captured the population level post-treatment dynamics of both HRP2 and <jats:italic>Plasmodium<\/jats:italic> LDH (pLDH), with the latter decaying more rapidly. Motivated by these differences in rates of decay, a novel algorithm that used HRP2:pLDH ratios to predict if an individual had active versus recently cleared <jats:italic>P. falciparum<\/jats:italic> infection was developed. The algorithm had 77.5% accuracy in correctly classifying antigen-positive individuals as those with and without active infection.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>These results characterize the performance of the ultra-sensitive RDT and demonstrate the potential for emerging antigen-quantifying technologies in the field of malaria diagnostics to be helpful tools in distinguishing between active versus recently cleared malaria infections.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12936-020-03389-0","type":"journal-article","created":{"date-parts":[[2020,9,3]],"date-time":"2020-09-03T11:03:42Z","timestamp":1599131022000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Ultra-sensitive RDT performance and antigen dynamics in a high-transmission Plasmodium falciparum setting in Mali"],"prefix":"10.1186","volume":"19","author":[{"given":"Emily N.","family":"Reichert","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jen C. 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Each village provided community permission and all participants provided informed consent. The study was approved by the Mali ethics review board (Facult\u00e9 de M\u00e9decine de Pharmacie et d\u2019OdontoStomatologie, Bamako), U.S. National Institute of Allergy and Infectious Diseases (NIAID, National Institutes of Health [NIH], Bethesda, MD) institutional review board, and Mali national regulatory authority, and was conducted under FDA IND 16251.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"323"}}