Journal
ELIFE
Volume 6, Issue -, Pages -Publisher
ELIFE SCIENCES PUBLICATIONS LTD
DOI: 10.7554/eLife.25008
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Funding
- Medical Research Council [MR/K010174/1B, MR/N01507X/1] Funding Source: researchfish
- MRC [MR/N01507X/1] Funding Source: UKRI
- Wellcome Trust [109312/Z/15/Z] Funding Source: Wellcome Trust
- Medical Research Council [MR/N01507X/1] Funding Source: Medline
- NIAID NIH HHS [R01 AI107949, T32 AI007151] Funding Source: Medline
- Wellcome Trust [109312/Z/15/Z] Funding Source: Medline
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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.
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