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By studying blood samples from a cohort of 12,572 participants enroled in a prospective, cross-sectional survey along Ethiopia\u2019s borders with Eritrea, Sudan and South Sudan using RDTs, PCR, an ultrasensitive bead-based immunoassay for antigen detection and next-generation sequencing, we estimate that histidine-rich protein 2-based RDTs would miss 9.7% (95% confidence interval 8.5\u201311.1) of\n                    <jats:italic>P. falciparum<\/jats:italic>\n                    malaria cases owing to\n                    <jats:italic>pfhrp2<\/jats:italic>\n                    deletion. We applied a molecular inversion probe-targeted deep sequencing approach to identify distinct subtelomeric deletion patterns and well-established\n                    <jats:italic>pfhrp3<\/jats:italic>\n                    deletions and to uncover recent expansion of a singular\n                    <jats:italic>pfhrp2<\/jats:italic>\n                    deletion in all regions sampled. We propose a model in which\n                    <jats:italic>pfhrp3<\/jats:italic>\n                    deletions have arisen independently multiple times, followed by strong positive selection for\n                    <jats:italic>pfhrp2<\/jats:italic>\n                    deletion owing to RDT-based test-and-treatment. Existing diagnostic strategies need to be urgently reconsidered in Ethiopia, and improved surveillance for\n                    <jats:italic>pfhrp2<\/jats:italic>\n                    deletion is needed throughout the Horn of Africa.\n                  <\/jats:p>","DOI":"10.1038\/s41564-021-00962-4","type":"journal-article","created":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T12:03:25Z","timestamp":1632744205000},"page":"1289-1299","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":168,"title":["Plasmodium falciparum is evolving to escape malaria rapid diagnostic tests in Ethiopia"],"prefix":"10.1038","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5778-653X","authenticated-orcid":false,"given":"Sindew M.","family":"Feleke","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4424-8908","authenticated-orcid":false,"given":"Emily N.","family":"Reichert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5677-9522","authenticated-orcid":false,"given":"Hussein","family":"Mohammed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bokretsion G.","family":"Brhane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalkidan","family":"Mekete","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9541-8976","authenticated-orcid":false,"given":"Hassen","family":"Mamo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beyene","family":"Petros","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiwot","family":"Solomon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ebba","family":"Abate","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Hennelly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeline","family":"Denton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3445-6589","authenticated-orcid":false,"given":"Corinna","family":"Keeler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas J.","family":"Hathaway","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan J.","family":"Juliano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey A.","family":"Bailey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Rogier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Cunningham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ozkan","family":"Aydemir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4465-9830","authenticated-orcid":false,"given":"Jonathan B.","family":"Parr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,9,27]]},"reference":[{"key":"962_CR1","unstructured":"False-negative RDT Results and Implications of New Reports of P. falciparum Histidine-rich Protein 2\/3 Gene Deletions (World Health Organization, 2016)."},{"key":"962_CR2","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1016\/S1473-3099(18)30420-1","volume":"18","author":"AK Verma","year":"2018","unstructured":"Verma, A. 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