{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T15:08:15Z","timestamp":1791644895782,"version":"4.3.4"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100013986","name":"UK government","doi-asserted-by":"crossref","award":["FCDO project number 300341-102"],"award-info":[{"award-number":["FCDO project number 300341-102"]}],"id":[{"id":"10.13039\/100013986","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Swiss Development Cooperation","award":["contract number 81071426"],"award-info":[{"award-number":["contract number 81071426"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Malaria remains a major global health challenge. Prompt, accurate diagnosis is crucial for effective case management. Current diagnostic approaches rely on invasive or minimally invasive sampling via venous or fingerpick blood draw, posing a risk to healthcare workers via the handling of potentially infectious body fluids. They may also be a barrier to recipients, particularly in malaria-endemic areas where there is routine testing of non-symptomatic individuals. Non-invasive tests based on saliva, exhaled volatile organic compounds (VOCs), and transdermal detection have the potential to increase case detection and linkage to care while reducing biosafety risks. Knowledge gaps exist regarding the feasibility and acceptability of these tools. This qualitative study, conducted in Indonesia, Peru, and Rwanda, aimed to generate evidence from end-users around the potential adoption of non-invasive diagnostic technologies, to determine whether these technologies are fit for purpose. Between October and November 2023, 24 semi-structured interviews were conducted with stakeholders and professionals working at borders, and 16 focus group discussions were conducted with caregivers of children under 5 years, pregnant women, healthcare workers, teachers and other community members (139 participants in total). The comfort non-invasive approaches offer to recipients of care was widely noted, especially compared with blood draw, which is considered painful for children. Ease of use and rapid diagnostic capabilities enabling real-time disease diagnosis were perceived as particularly beneficial in remote areas with limited healthcare infrastructure. Device portability was seen as a game-changer. Major concerns were the lack of information regarding the accuracy of non-invasive tools compared with established methods, the lack of trust in tests targeting specimens other than blood products, and their inability to differentiate between malaria species. Early engagement with stakeholders in the development of novel interventions is essential to ensure that end products meet the needs of communities.<\/jats:p>","DOI":"10.1371\/journal.pone.0318393","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T18:31:53Z","timestamp":1767983513000},"page":"e0318393","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["\u201cIt doesn\u2019t require blood!\u201d: Perceptions around non-invasive malaria testing tools in Indonesia, Peru, and Rwanda"],"prefix":"10.1371","volume":"21","author":[{"given":"Vanessa","family":"Fargnoli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5330-5516","authenticated-orcid":true,"given":"Serafina","family":"Calarco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5352-7688","authenticated-orcid":true,"given":"Catherine","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudius Novchovick","family":"Mone Iye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie A.","family":"Paz Soldan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy Celeste","family":"Morrison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janvier","family":"Serumondo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5551-6990","authenticated-orcid":true,"given":"Ladislas","family":"Nshimiyimana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne Delphine","family":"Nsaba Uwera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9715-0595","authenticated-orcid":true,"given":"Elena","family":"Marb\u00e1n-Castro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonjelle","family":"Shilton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2733-0037","authenticated-orcid":true,"given":"Kevin K.A.","family":"Tetteh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"pone.0318393.ref001","volume-title":"World malaria report 2023","year":"2023"},{"key":"pone.0318393.ref002","doi-asserted-by":"crossref","first-page":"119","DOI":"10.4269\/ajtmh.2007.77.119","article-title":"A review of malaria diagnostic tools: microscopy and rapid diagnostic test (RDT)","volume":"77","author":"C Wongsrichanalai","year":"2007","journal-title":"Am J Trop Med Hyg"},{"key":"pone.0318393.ref003","volume-title":"Malaria rapid diagnostic test performance: results of WHO product testing of malaria RDTs: round","year":"2018"},{"issue":"5","key":"pone.0318393.ref004","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1177\/193229680800200526","article-title":"Finger pricking and pain: a never ending story","volume":"2","author":"L Heinemann","year":"2008","journal-title":"J Diabetes Sci Technol"},{"key":"pone.0318393.ref005","doi-asserted-by":"crossref","first-page":"1006659","DOI":"10.3389\/fmicb.2022.1006659","article-title":"Advances and challenges in automated malaria diagnosis using digital microscopy imaging with artificial intelligence tools: A review","volume":"13","author":"CR Maturana","year":"2022","journal-title":"Frontiers in Microbiology"},{"issue":"7","key":"pone.0318393.ref006","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1093\/infdis\/jix094","article-title":"Implications of Parasites Lacking Plasmodium falciparum Histidine-Rich Protein 2 on Malaria Morbidity and Control When Rapid Diagnostic Tests Are Used for Diagnosis","volume":"215","author":"ML Gatton","year":"2017","journal-title":"J Infect Dis"},{"issue":"8","key":"pone.0318393.ref007","doi-asserted-by":"crossref","first-page":"558","DOI":"10.2471\/BLT.20.250621","article-title":"Prevalence of Plasmodium falciparum lacking histidine-rich proteins 2 and 3: a systematic review","volume":"98","author":"R Thomson","year":"2020","journal-title":"Bull World Health Organ"},{"issue":"3","key":"pone.0318393.ref008","first-page":"199","article-title":"Can a non-invasive urine-based test become the next-generation diagnostic tool for malaria?","volume":"26","author":"N Pradhan","year":"2018","journal-title":"Infez Med"},{"issue":"22","key":"pone.0318393.ref009","doi-asserted-by":"crossref","first-page":"5780","DOI":"10.1073\/pnas.1801512115","article-title":"Volatile biomarkers of symptomatic and asymptomatic malaria infection in humans","volume":"115","author":"CM De Moraes","year":"2018","journal-title":"Proceedings of the National Academy of Sciences of the United States of America"},{"issue":"2","key":"pone.0318393.ref010","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1007\/s11845-023-03506-3","article-title":"Potential of near-infrared spectroscopy (NIRS) as a non-invasive diagnostic tool to contain a global outbreak of malaria","volume":"193","author":"A Azhar","year":"2024","journal-title":"Ir J Med Sci"},{"key":"pone.0318393.ref011","author":"GHIT Fund Investment"},{"key":"pone.0318393.ref012","volume-title":"Malaria diagnostics market and technology landscape","author":"Unitaid","year":"2022"},{"issue":"3","key":"pone.0318393.ref013","article-title":"Rapid and non-invasive detection of malaria parasites using near-infrared spectroscopy and machine learning","volume":"19","author":"MT Sikulu-Lord","year":"2024","journal-title":"PLoS One"},{"issue":"5","key":"pone.0318393.ref014","doi-asserted-by":"crossref","DOI":"10.1093\/pnasnexus\/pgac272","article-title":"Malaria absorption peaks acquired through the skin of patients with infrared light can detect patients with varying parasitemia","volume":"1","author":"GA Garcia","year":"2022","journal-title":"PNAS Nexus"},{"issue":"2","key":"pone.0318393.ref015","doi-asserted-by":"crossref","first-page":"344","DOI":"10.3201\/eid2202.151829","article-title":"Transdermal Diagnosis of Malaria Using Vapor Nanobubbles","volume":"22","author":"E Lukianova-Hleb","year":"2016","journal-title":"Emerg Infect Dis"},{"issue":"473","key":"pone.0318393.ref016","article-title":"A saliva-based rapid test to quantify the infectious subclinical malaria parasite reservoir","volume":"11","author":"D Tao","year":"2019","journal-title":"Sci Transl Med"},{"issue":"12","key":"pone.0318393.ref017","doi-asserted-by":"crossref","first-page":"2244","DOI":"10.3390\/diagnostics11122244","article-title":"The Potential Use of Volatile Biomarkers for Malaria Diagnosis","volume":"11","author":"HC Chai","year":"2021","journal-title":"Diagnostics (Basel)"},{"issue":"9","key":"pone.0318393.ref018","article-title":"Point-of-care testing for infectious diseases: diversity, complexity, and barriers in low- and middle-income countries","volume":"9","author":"NP Pai","year":"2012","journal-title":"PLoS Med"},{"key":"pone.0318393.ref019","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1186\/1475-2875-7-148","article-title":"Malaria morbidity in Papua Indonesia, an area with multidrug resistant Plasmodium vivax and Plasmodium falciparum","volume":"7","author":"M Karyana","year":"2008","journal-title":"Malar J"},{"key":"pone.0318393.ref020","author":"Kementerian Kesehatan Republik Indonesia","year":"2021"},{"key":"pone.0318393.ref021","author":"RBC","year":"2023"},{"key":"pone.0318393.ref022","doi-asserted-by":"crossref","DOI":"10.1093\/infdis\/jiae570","article-title":"Malaria Surveillance: A Cross-sectional Study in the Peruvian Amazon Basin, 2012-2023","volume":"231","author":"JF Sanchez","year":"2025","journal-title":"J Infect Dis"},{"issue":"2","key":"pone.0318393.ref023","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3201\/eid0502.990204","article-title":"Malaria reemergence in the Peruvian Amazon region","volume":"5","author":"J Arambur\u00fa Guarda","year":"1999","journal-title":"Emerg Infect Dis"},{"issue":"6","key":"pone.0318393.ref024","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.4269\/ajtmh.15-0369","article-title":"Accelerating to Zero: Strategies to Eliminate Malaria in the Peruvian Amazon","volume":"94","author":"AM Quispe","year":"2016","journal-title":"Am J Trop Med Hyg"},{"key":"pone.0318393.ref025","author":"USAID"},{"issue":"1","key":"pone.0318393.ref026","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1186\/s12936-021-03911-y","article-title":"Acceptance and perceived value of non-invasive malaria diagnostic tests in malaria-endemic countries","volume":"20","author":"EDA Owusu","year":"2021","journal-title":"Malar J"},{"issue":"1","key":"pone.0318393.ref027","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1186\/s12936-023-04599-y","article-title":"A mixed methods study assessing the adoption potential of a saliva-based malaria rapid test in the Democratic Republic of Congo","volume":"22","author":"J Diaz","year":"2023","journal-title":"Malar J"},{"issue":"3","key":"pone.0318393.ref028","first-page":"186","article-title":"Malaria and pregnancy: a global health perspective","volume":"2","author":"J Schantz-Dunn","year":"2009","journal-title":"Rev Obstet Gynecol"},{"issue":"1","key":"pone.0318393.ref029","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s12916-019-1467-6","article-title":"Pregnancy-specific malarial immunity and risk of malaria in pregnancy and adverse birth outcomes: a systematic review","volume":"18","author":"JC Cutts","year":"2020","journal-title":"BMC Med"},{"key":"pone.0318393.ref030","volume-title":"Research methods in anthropology: qualitative and quantitative approaches","author":"HR Bernard","year":"2011","edition":"5"},{"issue":"6","key":"pone.0318393.ref031","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups","volume":"19","author":"A Tong","year":"2007","journal-title":"Int J Qual Health Care"},{"issue":"1","key":"pone.0318393.ref032","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s12936-025-05273-1","article-title":"Voices from the Amazon: exploring implementor and user perceptions of non-invasive malaria diagnostics in Peru","volume":"24","author":"L Nussbaum","year":"2025","journal-title":"Malar J"},{"issue":"1","key":"pone.0318393.ref033","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1186\/s12913-018-3844-9","article-title":"Integrated point-of-care testing (POCT) for HIV, syphilis, malaria and anaemia at antenatal facilities in western Kenya: a qualitative study exploring end-users\u2019 perspectives of appropriateness, acceptability and feasibility","volume":"19","author":"N Young","year":"2019","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pone.0318393.ref034","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1186\/s12936-022-04298-0","article-title":"Social representations of malaria in a southern malian community: an ethnographic qualitative study","volume":"21","author":"B Sissoko","year":"2022","journal-title":"Malar J"},{"issue":"1","key":"pone.0318393.ref035","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1186\/s12936-022-04423-z","article-title":"Mass screening and treatment (MSaT) for identifying and treating asymptomatic cases of malaria-malaria elimination demonstration project (MEDP), Mandla, Madhya Pradesh","volume":"21","author":"A Singh","year":"2022","journal-title":"Malar J"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0318393","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T18:32:01Z","timestamp":1767983521000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0318393"}},"subtitle":[],"editor":[{"given":"Susan","family":"Horton","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1,9]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0318393","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,9]]}}}