{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:32:57Z","timestamp":1787031177051,"version":"build-2736575974"},"reference-count":33,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,2]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Malaria rapid diagnostic tests (mRDTs) that detect histidine-rich protein 2 (HRP2) remain the mainstay of falciparum malaria diagnosis in Sub-Saharan Africa. Understanding their test characteristics when used for surveillance in asymptomatic populations is important. We explored the rate of false-positive and false-negative mRDT results among asymptomatic persons &gt;5 years old screened for malaria at schools and clinics in the rural Bagamoyo District using 18S ribosomal RNA real-time polymerase chain reaction (qPCR) as the reference test. Among 5,966 persons screened using mRDTs, microscopy, and qPCR tests from 2018 to 2021, 14% (832) were mRDT-positive. Twelve percent of these (98\/832) were negative by both microscopy and qPCR, with children overrepresented among those with false-positive mRDTs. Among those who were mRDT-negative, 22% (1,136\/5,134) tested qPCR-positive, predominantly because of low-density parasitemia (92% had &lt;100 p\/\u00b5L by qPCR). Among mRDT-negative samples with &gt;100 p\/\u00b5L, we looked for evidence of\n                    <jats:italic>hrp2<\/jats:italic>\n                    or histidine-rich protein 3 (\n                    <jats:italic>hrp3<\/jats:italic>\n                    ) deletion using two methods, multiplexed qPCR and multiplex bead-based immunoassay. When sufficient parasite material existed for a reliable deletion assessment, 12\/34 (35%) had evidence of\n                    <jats:italic>hrp2\/3<\/jats:italic>\n                    deletion by qPCR (nine\n                    <jats:italic>hrp2\u2013\/3+<\/jats:italic>\n                    and three\n                    <jats:italic>hrp2\u2013\/3\u2013<\/jats:italic>\n                    ), and 20\/52 (38%) had evidence of deletion by immunoassay. Only three isolates showed evidence of\n                    <jats:italic>hrp2<\/jats:italic>\n                    deletion by both assays. In an area of low to moderate transmission in Tanzania, false-positive mRDTs are relatively common (12% of positive tests), and false-negative mRDTs are even more common (22% of negative tests), but\n                    <jats:italic>hrp2\/3<\/jats:italic>\n                    deletion causing false-negative mRDTs remains rare (&lt;1% of negative tests).\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.24-0209","type":"journal-article","created":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T15:14:04Z","timestamp":1737472444000},"page":"765-770","source":"Crossref","is-referenced-by-count":2,"title":["Assessment of Malaria Rapid Diagnostic Tests and Histidine-Rich Protein 2 Deletions among Asymptomatic Children and Adults in Bagamoyo, Tanzania"],"prefix":"10.4269","volume":"112","author":[{"given":"Billy","family":"Ngasala","sequence":"first","affiliation":[{"name":"Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kofi B.","family":"Opoku","sequence":"additional","affiliation":[{"name":"Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kano","family":"Amagai","sequence":"additional","affiliation":[{"name":"Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashenafi","family":"Assefa","sequence":"additional","affiliation":[{"name":"Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina;"},{"name":"Ethiopian Public Health Institute, Addis Ababa, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mwajabu","family":"Loya","sequence":"additional","affiliation":[{"name":"Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mwanaidi","family":"Nyange","sequence":"additional","affiliation":[{"name":"Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meredith","family":"Muller","sequence":"additional","affiliation":[{"name":"Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamza","family":"Said","sequence":"additional","affiliation":[{"name":"Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Basham","sequence":"additional","affiliation":[{"name":"Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Rogier","sequence":"additional","affiliation":[{"name":"Division of Digestive Disease and Nutrition, University of Kentucky, Lexington, Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan J.","family":"Juliano","sequence":"additional","affiliation":[{"name":"Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan B.","family":"Parr","sequence":"additional","affiliation":[{"name":"Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica T.","family":"Lin","sequence":"additional","affiliation":[{"name":"Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"World Malaria Report 2022","year":"2022"},{"key":"b2","series-title":"Am J Trop Med Hyg","first-page":"192","article-title":"How do we best diagnose malaria in Africa?","volume":"86","author":"Rosenthal","year":"2012"},{"key":"b3","year":"2009"},{"key":"b4","series-title":"J Clin Microbiol","first-page":"4237","article-title":"Persistent histidine-rich protein 2, parasite lactate dehydrogenase, and panmalarial antigen reactivity after clearance of Plasmodium falciparum monoinfection","volume":"42","author":"Iqbal","year":"2004"},{"key":"b5","series-title":"Trop Med Infect 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