{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T15:24:58Z","timestamp":1793201098360,"version":"4.5.0"},"reference-count":61,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T00:00:00Z","timestamp":1747872000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["ebm-journal.org"],"crossmark-restriction":true},"short-container-title":["Exp. Biol. Med."],"abstract":"<jats:p>\n                    Malaria remains a significant cause of childhood morbidity and mortality, with\n                    <jats:italic>Plasmodium falciparum<\/jats:italic>\n                    Histidine-Rich Protein 2 (\n                    <jats:italic>Pf<\/jats:italic>\n                    HRP2)-based malaria rapid diagnostic tests (mRDTs) widely used in endemic regions where microscopy is sometimes not feasible. While these tests offer high sensitivity, persistent\n                    <jats:italic>Pf<\/jats:italic>\n                    HRP2 antigenemia and gene deletions can cause false-positive and false-negative results, compromising their accuracy for malaria case management and surveillance. This study evaluated the diagnostic performance and antigen persistence of\n                    <jats:italic>Pf<\/jats:italic>\n                    HRP2-mRDTs using data from a longitudinal birth cohort of 750 children followed monthly from birth to 36\u00a0months in a holoendemic region of Kenya. Malaria diagnosis was performed using both microscopy and mRDTs, with a total of 15,006 clinical events recorded from 573 children between 2017 and 2023. Data from an independent acute febrile cohort of 937 children (&amp;lt;5\u00a0years) followed for 14 days was analyzed to validate the findings. The mRDT showed a high sensitivity of 97.27% but a moderate specificity of 65.00% in acute febrile illness, indicating frequent false-positive results. The positive predictive value was low (35.10%), suggesting that confirmatory testing is needed, while the negative predictive value was high (98.89%), reinforcing the reliability of mRDTs in ruling out malaria. Persistent\n                    <jats:italic>Pf<\/jats:italic>\n                    HRP2 antigenemia was observed, with a median antigen clearance time of 51.14\u00a0days, respectively. Higher initial parasite densities (&amp;gt;50,000\/\u03bcL) were associated with a slower antigen decay rate (\n                    <jats:italic>p<\/jats:italic>\n                    = 0.001), highlighting the challenge of interpreting positive mRDT results after treatment. Validation using the acute febrile cohort showed that mRDT specificity exceeded 95% at initial diagnosis and follow-up. Overall,\n                    <jats:italic>Pf<\/jats:italic>\n                    HRP2-based mRDTs remain valuable for frontline malaria diagnosis but are limited by antigen persistence, leading to false positives in follow-up testing. Where feasible, integration of confirmatory diagnostic methods, such as microscopy or molecular assays, could improve the performance of malaria case management and clinical decision making, particularly in high-transmission settings.\n                  <\/jats:p>","DOI":"10.3389\/ebm.2025.10585","type":"journal-article","created":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T01:10:15Z","timestamp":1747876215000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Diagnostic accuracy of PfHRP2-based malaria rapid diagnostic tests and antigenemia persistence in Kenyan children from a holoendemic region: implications for case management and surveillance"],"prefix":"10.3389","volume":"250","author":[{"given":"Sharley A.","family":"Wasena","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clinton 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