# RDT-undetectable Malaria in the DR Congo: Epidemiology and Development of Alternatives

> **NIH NIH R01** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2021 · $47,586

## Abstract

ABSTRACT
Malaria-related mortality is falling, due in part to the implementation of rapid diagnostic tests (RDTs) and
artemisinin-based combination therapy (ACT) treatment programs. RDTs have become the primary modality
for diagnosis of malaria globally, including in Sub-Saharan Africa. Most widely used RDTs rely on the detection
of histidine-rich protein 2 (HRP2), an antigen specific to P​ lasmodium falciparum​ encoded by the ​pfhrp2​ gene.
However, false-negative results have recently been reported in individuals infected with P​ . falciparum ​parasites
harboring a deletion of the ​pfhrp2​ gene with or without a deletion in a related histidine-rich protein gene,
pfhrp3​. These parasites have been commonly described in South America and sporadically in other regions,
including Africa. Until recently, the prevalence and impact of ​pfhrp2​ deletions deletions in Africa was unknown.
We recently completed a large cross-sectional survey of more than 7,000 children in the Democratic Republic
of Congo (DRC), where RDTs have been the primary mode of diagnosis since 2011. We found that 6.4% of
parasitemic children had false-negative RDTs due to a p​ fhrp2​ deletion. In Kinshasa province, more than 20%
of infections were due to ​pfhrp2​-deleted parasites. Similar findings are being made in other parts of
Sub-Saharan Africa, raising the possibility that HRP2-based RDTs are becoming ineffective. Currently, our
collaborators are conducting a longitudinal cohort study in Kinshasa to evaluate the epidemiology of ​pfhrp2/3
deleted parasites. Our proposal will leverage this cohort to achieve our short-term goals to (1) understand the
evolutionary drivers of these deletions in the DRC, the country in Africa with the second-highest malaria
burden; and (2) to develop a simple PCR assay for ​pfhrp2/3​ deletion surveillance so that malaria control
programs can implement alternative diagnostics when needed. Our long-term goal is to develop alternate
biomarkers and noninvasive diagnostic tests for malaria diagnosis and test them in an area of HRP2-based
RDT failure. This proposal is unique in that it will help characterize an emerging public health problem while
simultaneously seeking solutions. As a result, there is a high likelihood that the results of this research will
significantly impact the next generation of point of care malaria diagnostic tests.

## Key facts

- **NIH application ID:** 10475414
- **Project number:** 3R01AI132547-04S1
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Rhoel David Ramos Dinglasan
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $47,586
- **Award type:** 3
- **Project period:** 2018-02-22 → 2023-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10475414

## Citation

> US National Institutes of Health, RePORTER application 10475414, RDT-undetectable Malaria in the DR Congo: Epidemiology and Development of Alternatives (3R01AI132547-04S1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10475414. Licensed CC0.

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