Solving malaria diagnostic resistance

Current Rapid Diagnostic Tests (RDTs) for Plasmodium falciparum malaria are based on the detection of the Histidine rich protein (pfhrp2&3). Widespread deletion of this protein can be found in the genome of parasites from Africa, Asia and South America and greatly reduces the reliability and accuracy of RDTs. This means we are missing patients for malaria treatment and this may threaten elimination campaigns.

The prevalence of pfhrp2&3 deletions is widespread reaching 80% in Eritrea, requiring an urgent response and policy change away from pfhrp2&3-only testing strategy. A recent Unitaid report which landscapes the malaria diagnostic market demonstrates the need for development non-HRP2 RDTs to combat a loss in sensitivity of current tests, and importantly, to avoid distrust in results gained from RDTs.

Working with collaborators in Kisumu Kenya and at LSHTM, this applicant will work on analysing the scale of the HRP2 problem, and developing alternative tests to the standard HRP2 RDTs with our industry partners. 

Where does the project lie on the Translational Pathway?

T2 Human/Clinical Research + T3 Evidence into Practice

Expected Outputs


The main output of this PhD programme will be evidence of diagnostic resistance for malaria, and solutions to this diagnostic dilemma.

We expect to publish at least two high quality papers, and are currently applying to MRC to support future efforts. We encourage the PhD student to apply for small grants during the PhD, and by the end of the programme to apply for fellowships with our support.


Training Opportunities

Training will be provided in novel approaches for diagnostic and surveillance, close contact with industrial partners

Skills Required


Knowledge of global health, diagnostic evaluation and molecular techniques preferable but can be developed 


Key Publications associated with this project

Efficacy and safety of intermittent preventive treatment and intermittent screening and treatment versus single screening and treatment with dihydroartemisinin-piperaquine for the control of malaria in pregnancy in Indonesia: a cluster-randomised, open-label, superiority trial.Ahmed R, Poespoprodjo JR, Syafruddin D, Khairallah C, Pace C, Lukito T, Maratina SS, Asih PBS, Santana-Morales MA, Adams ER, Unwin VT, Williams CT, Chen T, Smedley J, Wang D, Faragher B, Price RN, Ter Kuile FO. Lancet Infect Dis. 2019 Sep;19(9):973-987. doi: 10.1016/S1473-3099(19)30156-2. Epub 2019 Jul 25.
Use of a highly-sensitive rapid diagnostic test to screen for malaria in pregnancy in IndonesiaVera T Unwin Rukhsana Ahmed, Rintis Noviyanti, Agatha Mia Puspitasari, Retno Ayu Setya Utami, Leily Trianty, Theda Lukito, Din Syafruddin, Jeanne Poespoprodjo, Maria Santana-Morales, Feiko Ter Kuile, Emily Adams. In review
Development of a rapid field-applicable molecular diagnostic for knockdown resistance (kdr) markers in An. gambiae. Unwin VTAinsworth SRippon EJNiang EHAPaine MJIWeetman DAdams ER. Parasit Vectors. 2018 May 18;11(1):307. doi: 10.1186/s13071-018-2893-6.
Performance of four HRP-2/pLDH combination rapid diagnostic tests and field microscopy as screening tests for malaria in pregnancy in Indonesia: a cross-sectional study.

Ahmed RLevy EIMaratina SSde Jong JJAsih PBRozi IEHawley WSyafruddin Dter Kuile F. Malar J. 2015 Oct 29;14:420. doi: 10.1186/s12936-015-0943-5. 

LSTM Themes and Topics – Key Words

Diagnostics, malaria epidemiology