“It doesn’t require blood!” - Perceptions around non-invasive malaria testing tools in Indonesia, Peru, and Rwanda

Sep 30, 2026

Malaria remains a major global health challenge, where prompt, accurate diagnosis is essential for effective case management. Current invasive or minimally invasive blood sampling via venous or fingerpick methods risks healthcare workers handling potentially infectious fluids and can deter recipients, especially for routine testing of non-symptomatic people in endemic settings. This qualitative study in Indonesia, Peru, and Rwanda explores end-user feasibility and acceptability of non-invasive tools, aiming to assess whether they are fit for purpose.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages24

Reading Time1 h 0 min

AccessFree to download

Abstract

Study aim

Study design and participants

Key perceived benefits

Key concerns

OPEN ACCESS Citation: Fargnoli V, Calarco S, Thomas C, Thomas C, Mone Iye CN, Paz Soldan VA, et al.(2026) “It doesn’t require blood!”: Perceptions around non-invasive malaria testing tools in Indonesia, Peru, and Rwanda. PLoS One 21(1): e0318393. [https://doi.org/10.1371/journal](https://doi.org/10.1371/journal). pone.0318393 Editor: Susan Horton, University of Waterloo, CANADA Received: February 3, 2025 Accepted: October 18, 2025 Published: January 9, 2026 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: [https://doi.org/10.1371/journal](https://doi.org/10.1371/journal). pone.0318393 Copyright: © 2026 Fargnoli et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, RESEARCH ARTICLE “It doesn’t require blood!”: Perceptions around non-invasive malaria testing tools in Indonesia, Peru, and Rwanda Vanessa Fargnoli1‡, Serafina Calarco1‡*, Catherine Thomas2, Caroline Thomas3, Claudius Novchovick Mone Iye3, Valerie A. Paz Soldan4,5, Amy Celeste Morrison4,6, Janvier Serumondo7, Ladislas Nshimiyimana7, Yvonne Delphine Nsaba Uwera8, Elena Marbán-Castro1, Sonjelle Shilton1‡, Kevin K.A. Tetteh1‡ 1 FIND, Geneva, Switzerland, 2 University of Jakarta International, Jakarta, Indonesia, 3 Yayasan Peduli Hati Bangsa, Jakarta, Indonesia, 4 Asociación Benéfica Prisma, Lima, Peru, 5 Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America, 6 University of California, Davis, California, United States of America, 7 Rwanda Biomedical Center, Kigali, Rwanda, 8 University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda ‡ VF and SC are Co-first authors on this work. SS and KKAT are Co-last authors on this work. * [Serafina.calarco@finddx.org](Serafina.calarco@finddx.org) Abstract 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 PLOS One | [https://doi.org/10.13

FAQs

Why are non-invasive malaria tests being considered in endemic settings?

Non-invasive tests may improve case detection and linkage to care while reducing biosafety risks for healthcare workers and lowering barriers for recipients, especially where testing includes non-symptomatic individuals.

How was the qualitative evidence gathered in this study?

Between October and November 2023, the study conducted 24 semi-structured interviews with stakeholders and professionals at borders and 16 focus group discussions with caregivers of children under 5, pregnant women, healthcare workers, teachers, and other community members.

What major concerns did participants raise about non-invasive testing tools?

Participants highlighted concerns about limited information on the accuracy of non-invasive tools compared with established methods and the reproduction of results in practice.

Sep 30, 2026

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