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Background  Malaria rapid diagnostic tests based on histidine-rich protein-2 have played a vital role in improving malaria case management and surveillance particularly in Africa, where  Plasmodium falciparum  is predominant. However, their usefulness has been threatened by the emergence of gene deletion on  P. falciparum histidine rich protein 2  ( pfhrp2 ) and  P. falciparum histidine rich protein 3  ( pfhrp3 ). Use of standard and recommended methods is key for accurate investigation, confirmation and reporting of  pfhrp2  and  pfhrp3  gene deletion.    Methods  A systematic review was conducted to assess the status, methods and approaches that have been used for investigation, confirmation and reporting of  pfhrp2  and  pfhrp3  gene deletion in Africa. An online search was done using PubMed and MEDLINE Google Scholar for all articles published in English on  pfhrp2/3  gene deletion in Africa. Relevant articles that met the inclusion criteria were summarized and assessed based on the protocol recommended by the World Health Organization for confirmation and reporting of  pfhrp2/3  gene deletion.    Results  The search identified a total of 18 articles out of which 14 (77.7%) fulfilled the criteria for inclusion and were retained for review. The articles were distributed across 12 countries where the p fhrp2  and  pfhrp3  gene deletion studies were conducted and reported. The level of  pfhrp2/3  gene deletion across selected studies in Africa ranged from the highest 62% to the lowest 0.4%. There was wide variation in methods and approaches including study designs, size and sampling and whether both  pfhrp2  and  pfhrp3  double deletions or  pfhrp2  single deletion were investigated, with a wide variation in laboratory methods.    Conclusion  Based on the review, there is evidence of the presence of  pfhrp2/3  gene-deleted  P. falciparum  parasites in Africa. The approaches and methods used for investigation, confirmation and reporting of  pfhrp2/3  deleted parasites have varied between studies and across countries. Countries that are considering plans to investigate, confirm and report  pfhrp2/3  deletion should use recommended standard and harmonized methods to prevent unnecessary recommendations for costly switch of RDTs in Africa.

malaria journal

Systematic review of the status of pfhrp2 and pfhrp3 gene deletion, approaches and methods used for its estimation and reporting in Plasmodium falciparum populations in Africa: review of published studies 2010–2019