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Histidine-rich protein-2 (HRP2) antigen detection RDTs are predominantly used to diagnose\n                      <jats:italic>Plasmodium falciparum<\/jats:italic>\n                      infection. However, the evolution and spread of\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      parasite strains with deleted\n                      <jats:italic>hrp2\/3<\/jats:italic>\n                      genes, causing false-negative results, have been reported. This study assessed the diagnostic performance of HRP2-detecting RDTs for\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      cases and the prevalence of\n                      <jats:italic>pfhrp2\/3<\/jats:italic>\n                      deletions among symptomatic patients seeking malaria diagnosis at selected health facilities in southern Ethiopia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A multi-health facilities-based cross-sectional study was conducted on self-presenting febrile patients seeking treatment in southern Ethiopia from July to September 2022. A purposive sampling strategy was used to enroll patients with microscopically confirmed\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      infections. A capillary blood sample was obtained to prepare a blood film for microscopy and a RDT using the SD Bioline\u2122 Malaria Pf\/Pv Test. Dried blood spot samples were collected for further molecular analysis. DNA was extracted using gene aid kits and amplification was performed using nested PCR assay.\n                      <jats:italic>Exon 2<\/jats:italic>\n                      of\n                      <jats:italic>hrp2<\/jats:italic>\n                      and\n                      <jats:italic>hrp3<\/jats:italic>\n                      , which are the main protein-coding regions, was used to confirm its deletion. The diagnostic performance of RDT was evaluated using PCR as the gold standard test for\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      infections.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 279\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      PCR-confirmed samples, 249 (89.2%) had successful\n                      <jats:italic>msp-2<\/jats:italic>\n                      amplification, which was then genotyped for\n                      <jats:italic>hrp2\/3<\/jats:italic>\n                      gene deletions. The study revealed that\n                      <jats:italic>pfhrp2\/3<\/jats:italic>\n                      deletions were common in all health centres, and it was estimated that 144 patients (57.8%) across all health facilities had\n                      <jats:italic>pfhrp2\/3<\/jats:italic>\n                      deletions, leading to false-negative PfHRP2 RDT results. Deletions spanning exon 2 of\n                      <jats:italic>hrp2<\/jats:italic>\n                      , exon 2\n                      <jats:italic>of hrp3<\/jats:italic>\n                      , and double deletions (hrp2\/3) accounted for 68 (27.3%), 76 (30.5%), and 33 (13.2%) of cases, respectively. The study findings revealed the prevalence of\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      parasites lacking a single\n                      <jats:italic>pfhrp2-\/3-<\/jats:italic>\n                      gene and that both genes varied across the study sites. This study also showed that the sensitivity of the SD Bioline PfHRP2-RDT test was 76.5% when PCR was used as the reference test.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      This study confirmed the existence of widespread\n                      <jats:italic>pfhrp2\/3-<\/jats:italic>\n                      gene deletions, and their magnitude exceeded the WHO-recommended threshold (&gt;\u20095%). False-negative RDT results resulting from deletions in\n                      <jats:italic>Pfhrp2\/3<\/jats:italic>\n                      - affect a country\u2019s attempts at malaria control and elimination. Therefore, the adoption of non-HRP2-based RDTs as an alternative measure is required to avoid the consequences associated with the continued use of HRP-2-based RDTs, in the study area in particular and in Ethiopia in general.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12936-024-04904-3","type":"journal-article","created":{"date-parts":[[2024,4,17]],"date-time":"2024-04-17T11:02:22Z","timestamp":1713351742000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["Widespread pfhrp2\/3 deletions and HRP2-based false-negative results in southern Ethiopia"],"prefix":"10.1186","volume":"23","author":[{"given":"Bacha","family":"Mekonen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sisay","family":"Dugassa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sindew Mekasha","family":"Feleke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boja","family":"Dufera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bedasa","family":"Gidisa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aderaw","family":"Adamu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aynalem","family":"Mandefro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geremew","family":"Tasew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lemu","family":"Golassa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,4,17]]},"reference":[{"key":"4904_CR1","volume-title":"World malaria report 2020: 20 years of global progress and challenges","author":"WHO","year":"2020","unstructured":"WHO. 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