A Countrywide Survey of Hrp2/3 Deletions and Kelch13 Mutations Co-occurrence in Ethiopia

Malaria elimination relies on detection of Plasmodium falciparum histidine-rich proteins 2/3 (HRP2/3) through rapid diagnostic tests (RDTs) and treatment with artemisinin combination therapies (ACTs). Data from the Horn of Africa suggest increasing hrp2/3 gene deletions and ACT partial resistance kelch13 (k13) mutations. To assess this, 233 samples collected during a national survey from 7 regions of Ethiopia were studied for hrp2/3 deletions with droplet digital polymerase chain reaction (ddPCR) and k13 mutations with DNA sequencing. Approximately 22% of the study population harbored complete hrp2/3 deletions by ddPCR. Thirty-two of 44 of k13 single-nucleotide polymorphisms identified were R622I associated with ACT partial resistance. Both hrp2/3 deletions and k13 mutations associated with ACT partial resistance appear to be co-occurring, especially in Northwest Ethiopia. Ongoing national surveillance relying on accurate laboratory methods are required to elaborate the genetic diversity of P. falciparum.