Examining the Early Distribution of the Artemisinin-Resistant R561H Mutation in Areas of Higher Transmission in Rwanda.

BACKGROUND

Artemisinin resistance mutations in () have begun to emerge in Africa, with R561H being the first reported in Rwanda in 2014, but limited sampling left questions about its early distribution and origin.

METHODS

We genotyped positive dried blood spot (DBS) samples from a nationally representative 2014-2015 Rwanda Demographic Health Surveys (DHS) HIV study. DBS were subsampled from DHS sampling clusters with >15% prevalence, as determined by rapid testing or microscopy done during the DHS study (n clusters = 67, n samples = 1873).

RESULTS

We detected 476 parasitemias among 1873 residual blood spots from a 2014-2015 Rwanda Demographic Health Survey. We sequenced 351 samples: 341/351 were wild-type (97.03% weighted), and 4 samples (1.34% weighted) harbored R561H that were significantly spatially clustered. Other nonsynonymous mutations found were V555A (3), C532W (1), and G533A (1).

CONCLUSIONS

Our study better defines the early distribution of R561H in Rwanda. Previous studies only observed the mutation in Masaka as of 2014, but our study indicates its presence in higher-transmission regions in the southeast of the country at that time.