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The majority of commercial RDTs used in Africa detect the <jats:italic>Plasmodium falciparum<\/jats:italic> histidine-rich protein 2 (PfHRP2). <jats:italic>pfhrp2\/3<\/jats:italic>\u00a0gene deletions can therefore lead to false-negative RDT results. This study aimed to evaluate the frequency of PCR-confirmed, false-negative <jats:italic>P. falciparum<\/jats:italic> RDT results in Monrovia, Liberia.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>PfHRP2-based RDT (Paracheck Pf\u00ae) and microscopy results from 1038 individuals with fever or history of fever (n\u2009=\u2009951) and pregnant women at first antenatal care (ANC) visit (n\u2009=\u200987) enrolled in the Saint Joseph\u2019s Catholic Hospital (Monrovia) from March to July 2019 were used to assess the frequency of false-negative RDT results. True\u2013false negatives were confirmed by detecting the presence of <jats:italic>P. falciparum<\/jats:italic> DNA by quantitative PCR in samples from individuals with discrepant RDT and microscopy results. Samples that were positive by 18S rRNA qPCR but negative by PfHRP2-RDT were subjected to multiplex qPCR assay for detection of <jats:italic>pfhrp2<\/jats:italic> and <jats:italic>pfhrp3<\/jats:italic>.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>One-hundred and eighty-six (19.6%) and 200 (21.0%) of the 951 febrile participants had a <jats:italic>P. falciparum<\/jats:italic>-positive result by RDT and microscopy, respectively. Positivity rate increased with age and the reporting of joint pain, chills and shivers, vomiting and weakness, and decreased with the presence of coughs and nausea. The positivity rate at first ANC visit was 5.7% (n\u2009=\u20095) and 8% (n\u2009=\u20097) by RDT and microscopy, respectively. Out of 207 <jats:italic>Plasmodium<\/jats:italic> infections detected by microscopy, 22 (11%) were negative by RDT. qPCR confirmed absence of <jats:italic>P. falciparum<\/jats:italic> DNA in the 16 RDT-negative but microscopy-positive samples which were available for molecular testing. Among the 14 samples that were positive by qPCR but negative by RDT and microscopy, 3 only amplified <jats:italic>pfldh<\/jats:italic>, and among these 3 all were positive for <jats:italic>pfhrp2<\/jats:italic> and <jats:italic>pfhrp3<\/jats:italic>.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>There is no qPCR-confirmed evidence of false-negative RDT results due to <jats:italic>pfhrp2\/pfhrp3<\/jats:italic> deletions in this study conducted in Monrovia (Liberia). This indicates that these deletions are not expected to affect the performance of PfHRP2-based RDTs for the diagnosis of malaria in Liberia. Nevertheless, active surveillance for the emergence of PfHRP2 deletions is required.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12936-021-03774-3","type":"journal-article","created":{"date-parts":[[2021,5,26]],"date-time":"2021-05-26T20:03:20Z","timestamp":1622059400000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["No evidence of false-negative Plasmodium falciparum rapid diagnostic results in Monrovia, Liberia"],"prefix":"10.1186","volume":"20","author":[{"given":"Mandella","family":"King","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander E.","family":"George","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pau","family":"Cister\u00f3","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine K.","family":"Tarr-Attia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatriz","family":"Arregui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Senga","family":"Omeonga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haily","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Meyer Garc\u00eda-S\u00edpido","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adelaida","family":"Sarukhan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Quique","family":"Bassat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dawoh Peter","family":"Lansana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3890-2897","authenticated-orcid":false,"given":"Alfredo","family":"Mayor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,5,26]]},"reference":[{"key":"3774_CR1","doi-asserted-by":"publisher","first-page":"e1003359","DOI":"10.1371\/journal.pmed.1003359","volume":"17","author":"A Mousa","year":"2020","unstructured":"Mousa A, Al-Taiar A, Anstey NM, Badaut C, Barber BE, Bassat Q, et al. 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Parental consents in addition to minor assent were obtained from the participants aged younger than 18\u00a0years. Participants did not receive any retribution for their engagement as study subjects. Refusal to participate in this study did not affect service provision as per standard health care practice. This research protocol was approved by the local University of Liberia-Pacific Institute Research and Evaluation Institutional Review Board (UL-PIRE, Monrovia, Liberia) and by the Hospital Cl\u00ednic Health Research Ethics Committee (CEIC, Barcelona, Spain). Study participants were treated following national guidelines.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"238"}}