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Modelling the drivers of the spread of Plasmodium falciparum hrp2 gene deletions in sub-Saharan Africa

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Title: Modelling the drivers of the spread of Plasmodium falciparum hrp2 gene deletions in sub-Saharan Africa
Authors: Watson, O
Slater, HC
Verity, R
Parr, JB
Mwandagalirwa, MK
Tshefu, A
Meshnick, SR
Ghani, AC
Item Type: Journal Article
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.
Issue Date: 29-Aug-2017
Date of Acceptance: 21-Aug-2017
URI: http://hdl.handle.net/10044/1/50471
DOI: https://dx.doi.org/10.7554/eLife.25008
ISSN: 2050-084X
Publisher: eLife Sciences Publications Ltd
Journal / Book Title: eLife
Volume: 6
Copyright Statement: © 2017, Watson et al. This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.
Sponsor/Funder: Bill & Melinda Gates Foundation
Medical Research Council (MRC)
Wellcome Trust
Funder's Grant Number: OPP1068440
MR/K010174/1B
109312/Z/15/Z
Keywords: P. falciparum
epidemiology
global health
Publication Status: Published
Article Number: e25008
Appears in Collections:Centre for Environmental Policy
Faculty of Medicine
Faculty of Natural Sciences
Epidemiology, Public Health and Primary Care



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