Prevalence of pfhrp2/pfhrp3 gene deletions among patients with Plasmodium falciparum malaria with false-negative in the HRP2-based rapid diagnostic test in Colombia

BACKGROUND In malaria-endemic regions, rapid diagnostic tests (RDTs) play a crucial role in promptly identifying infections, especially in remote areas with limited microscopy services. OBJECTIVES Conduct a cross-sectional, multi-site study to determine whether the local prevalence of mutations in the Plasmodium falciparum hrp2/3 genes in false-negative RDTs has reached a threshold that might require a local or national change in diagnostic strategy in accordance with the WHO guidelines (2018). METHODS Individuals were screened for P. falciparum with microscopy and HRP2-based RDT at health facilities. Discordant results between these two tests triggered diagnostic confirmation by polymerase chain reaction (PCR) and detection of the pfhrp2/pfhrp3 genes. FINDINGS Among the 347 patients included, false negatives constituted 4.61% (16/347). Molecular analysis revealed all 16 false negatives were P. falciparum positive with hrp2 gene present, displaying high polymorphism. However, hrp3 gene deletion was observed in 93.8% (15/16) of these cases. MAIN CONCLUSIONS The prevalence of false-negative RDTs is low, and these results were not linked to deletions in the hrp2 gene. This suggests that there is no immediate need to modify the RDTs used along the Colombian Pacific Coast. However, molecular surveillance for hrp2 deletions remains crucial to detect any potential increase in prevalence.