Prevalence of Plasmodium falciparum parasites with Pfhrp2 exon 2 gene deletion in symptomatic malaria patients across Ghana in 2021

Background Plasmodium falciparum histidine-rich protein 2-based RDTs (PfHRP2-based RDTs) are the most widely used malaria RDTs across Africa. The emergence and spread of Pfhrp2 gene-deleted parasites has prompted nationwide surveillance to monitor trends and potential hotspots for mutant parasite clones. This study aimed to assess the prevalence and distribution of Pfhrp2 gene deletions in Ghana. Methods The First Response® HRP2 RDT (First Response RDT) and CareStart™ HRP2/panLDH Combo RDT (Combo kit) were used to screen suspected malaria individuals seeking care in 160 public healthcare facilities across all 16 regions of Ghana, between June and August 2021. DNA was extracted from the dry blood spots to confirm the presence of P. falciparum and subsequently, Pfhrp2 gene deletion by PCR. Results The overall malaria positivity for the two RDTs was similar: 72.3% (95% CI: 71.4–73.2) for the First Response RDT and 71.5% (95% CI: 70.6–72.4) for the HRP2/panLDH Combo kit (p = 0.215). Pfhrp2 exon 2 gene deletions were identified in 0.3% (19/5,611) of samples that tested positive for both the First Response RDT and the panLDH band of the Combo kit, and 9.1% (2/22) of the missed infections, leading to an overall Pfhrp2 exon 2 gene deletion of 0.4% (21/5,633). Conclusion The present work conducted in 2021, determined Pfhrp2 deletions in Ghana to be less than 1% with almost equal distribution across 16 regions. This finding offers assurance for the continued reliance on HRP2-based RDTs for screening in public health clinics in Ghana.