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Citation Information

Type Journal Article - eLife
Title Modelling the drivers of the spread of Plasmodium falciparum hrp2 gene deletions in sub-Saharan Africa
Author(s)
Volume 6
Publication (Day/Month/Year) 2017
URL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602420/
Abstract
Rapid diagnostic tests (RDTs) have transformed malaria diagnosis. The most prevalent P. falciparum RDTs detect histidine-rich protein 2 (PfHRP2). However, pfhrp2 gene deletions yielding false-negative RDTs, first reported in South America in 2010, have been confirmed in Africa and Asia. We developed a mathematical model to explore the potential for RDT-led diagnosis to drive selection of pfhrp2-deleted parasites. Low malaria prevalence and high frequencies of people seeking treatment resulted in the greatest selection pressure. Calibrating our model against confirmed pfhrp2-deletions in the Democratic Republic of Congo, we estimate a starting frequency of 6% pfhrp2-deletion prior to RDT introduction. Furthermore, the patterns observed necessitate a degree of selection driven by the introduction of PfHRP2-based RDT-guided treatment. Combining this with parasite prevalence and treatment coverage estimates, we map the model-predicted spread of pfhrp2-deletion, and identify the geographic regions in which surveillance for pfhrp2-deletion should be prioritised.

Related studies

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Watson, Oliver J, Hannah C Slater, Robert Verity, Jonathan B Parr, Melchior K Mwandagalirwa, Antoinette Tshefu, Steven R Meshnick, and Azra C Ghani. "Modelling the drivers of the spread of Plasmodium falciparum hrp2 gene deletions in sub-Saharan Africa." eLife (2017).
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