Modelling the drivers of the spread of Plasmodium falciparum hrp2 gene deletions in sub-Saharan Africa
- Imperial College London, United Kingdom
- University of North Carolina, United States
- University of Kinshasa, Democratic Republic of the Congo
- University of Kinshasa, Democratic People's Republic of Korea
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.
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Author details
Oliver John Watson
Funding
Wellcome (109312/Z/15/Z)
- Oliver John Watson
National Institute of Allergy and Infectious Diseases (5R01AI107949)
- Steven R Meshnick
Imperial College London
- Hannah C Slater
Medical Research Council (MR/N01507X/1)
- Robert Verity
Department for International Development
- Azra C Ghani
National Institute of Allergy and Infectious Diseases (5T32AI007151)
- Jonathan B Parr
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Copyright
© 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.
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Modelling the drivers of the spread of Plasmodium falciparum hrp2 gene deletions in sub-Saharan Africa
eLife 6:e25008.
https://doi.org/10.7554/eLife.25008
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