Further evidence needed to change policy for the safe and effective radical cure of vivax malaria: Insights from the 2019 annual APMEN Vivax Working Group meeting

Ruwanpura, Varunika Sonani Hapuwatte; Nowak, Spike; Gerth‐Guyette, Emily; Theodora, Minerva; Lek, Dysoley; Haile, Mebratom; Grietens, Koen Peeters; Price, Ric N.; Lynch, Caroline; Thriemer, Kamala

doi:10.1002/app5.314

Cited by 5 publications

(4 citation statements)

References 42 publications

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“…Current malaria policies usually reflect associated funding by the Global Fund, so it is unclear whether the cost-effectiveness of G6PD testing is an important driver in country-level decision making. However national malaria control programs have ranked cost effectiveness of new approaches as a key area for further research [ 164 ], suggesting that this has some impact on policy decisions. Whether an intervention such as G6PD testing is considered cost-effective will also depend on the budget available, which could be a national health budget or a budget specifically for malaria control [ 165 ].…”

Section: Other Considerations For the Update Of Novel Diagnosticsmentioning

confidence: 99%

A Review of the Current Status of G6PD Deficiency Testing to Guide Radical Cure Treatment for Vivax Malaria

et al. 2023

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Plasmodium vivax malaria continues to cause a significant burden of disease in the Asia-Pacific, the Horn of Africa, and the Americas. In addition to schizontocidal treatment, the 8-aminoquinoline drugs are crucial for the complete removal of the parasite from the human host (radical cure). While well tolerated in most recipients, 8-aminoquinolines can cause severe haemolysis in glucose-6-phosphate dehydrogenase (G6PD) deficient patients. G6PD deficiency is one of the most common enzymopathies worldwide; therefore, the WHO recommends routine testing to guide 8-aminoquinoline based treatment for vivax malaria whenever possible. In practice, this is not yet implemented in most malaria endemic countries. This review provides an update of the characteristics of the most used G6PD diagnostics. We describe the current state of policy and implementation of routine point-of-care G6PD testing in malaria endemic countries and highlight key knowledge gaps that hinder broader implementation. Identified challenges include optimal training of health facility staff on point-of-care diagnostics, quality control of novel G6PD diagnostics, and culturally appropriate information and communication with affected communities around G6PD deficiency and implications for treatment.

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Section: Other Considerations For the Update Of Novel Diagnosticsmentioning

confidence: 99%

A Review of the Current Status of G6PD Deficiency Testing to Guide Radical Cure Treatment for Vivax Malaria

et al. 2023

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“…However, shortening the timelines for policy change is pivotal to meet proposed malaria elimination milestones of 2030 and country-level preparedness is therefore key to accelerating the policy decision process. NMPs in the Asia Pacific region have identified the need for more support to make informed decisions for optimal new radical cure options as they become available [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Optimizing test and treat options for vivax malaria: An options assessment toolkit (OAT) for Asia Pacific national malaria control programs

Acharya,

Shrestha,

Thang

et al. 2024

PLOS Glob Public Health

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Designing policy in public health is a complex process requiring decision making that incorporates available evidence and is suitable to a country’s epidemiological and health system context. The main objective of this study was to develop an options assessment toolkit (OAT) to provide a pragmatic and evidence-based approach to the development of policies for the radical cure (prevention of relapse) of vivax malaria for national malaria control programs in the Asia-Pacific region. The OAT was developed using participatory research methods and a Delphi process using a sequential multi-phase design, adapted with a pre-development phase, a development phase, and a final development phase. In the pre-development phase, a literature review was conducted to inform the toolkit development. Data collection in the development phase consisted of core research team discussions, multiple rounds of consultation with participants from National Malaria Control Programs (NMP) (online and in person), and two separate modified e-Delphi processes with experts. The final development phase was the piloting of the toolkit during the annual meeting of the Asia Pacific Malaria Elimination Network (APMEN) Vivax Working Group. We developed a tool kit containing the following elements: i) Baseline Assessment Tool (BAT) to assess the readiness of NMPs for new or improved coverage of radical cure, ii) eight scenarios representative of Asia Pacific region, iii) matching test and treat options based on available options for G6PD testing and radical cure for the given scenarios, iv) an approaches tool to allow NMPs to visualize considerations for policy change process and different implementation strategies/approaches for each test and treat option. The OAT can support vivax radical cure policy formulation among NMPs and stakeholders tailoring for their unique country context. Future studies are needed to assess the utility and practicality of using the OAT for specific country context.

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“…In November 2019, Cambodia began trialling the use of a 14day low-dose PQ (0.25 mg/kg) intervention for adult males with a diagnosed P. vivax infection testing G6PD normal with qualitative G6PD rapid diagnostic tests (RDTs) in two health centres in Pursat province [15], and has since rolled this out as part of the national programme (Table 1). Ongoing policy changes to safely im- plement the effective radical cure for P. vivax in Cambodia are an important part of the regional strategy malaria elimination strategy [16].…”

Section: Introductionmentioning

confidence: 99%

Is a radical cure enough? Assessing a primaquine treatment for adult males in Cambodia to eliminate vivax malaria by 2025

Martin-Hughes

Hickson

Price

et al. 2022

Preprint

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Background: Elimination targets for Plasmodium vivax are approaching, wit the Cambodian target of 2025. Quantitative tools can assess if proposed strategies are likely to be sufficient to meet those targets. Methods: We calibrated the Optima Malaria transmission model to reported case data from 2011–2018 for six provinces with different transmission levels. The model had two human populations: males aged 15 years and older, and everyone else. We assessed the addition of the new low-dose primaquine intervention (0.25 mg/kg daily x 14 days) for diagnosed P. vivax infections where males aged 15 years and older were prescribed primaquine after testing glucose-6-phosphate-dehydrognase normal to the 2018 status quo (blood-stage treatment only). Results were evaluated over stochastic iterations of the calibrated compartmental model, incorporating best and worst case interpretations of the available case data given uncertainty over underlying P. vivax incidence in 2020.Results: Under 2018 status quo conditions in the absence of primaquine radical cure, we found that P. vivax elimination would be unlikely to be achieved by 2040 in any province. Elimination by 2025 was not projected in any province even with best case assumptions for primaquine intervention coverage, G6PD-based eligibility, and primaquine efficacy; however, we estimated that the addition of the primaquine intervention could reduce P. vivax transmission by 67%-83% by 2025. We found that sustained application of the primaquine intervention was likely to result in elimination by 2040 in all six provinces with best case estimated baseline incidence, and in the two lowest incidence provinces with worst case baseline incidence.Conclusions: Without additional novel interventions, the primaquine radical cure (0.25 mg/kg daily x 14 days targeting adult males with diagnosed P. vivax infections) is not projected to result in elimination from any province by the 2025 target even under the most optimistic interpretation of the available case data. However, the implementation of a primaquine intervention in Cambodia is likely to have a substantial impact on transmission of P. vivax and may make elimination feasible over the longer term.

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Further evidence needed to change policy for the safe and effective radical cure of vivax malaria: Insights from the 2019 annual APMEN Vivax Working Group meeting

Cited by 5 publications

References 42 publications

A Review of the Current Status of G6PD Deficiency Testing to Guide Radical Cure Treatment for Vivax Malaria

A Review of the Current Status of G6PD Deficiency Testing to Guide Radical Cure Treatment for Vivax Malaria

Optimizing test and treat options for vivax malaria: An options assessment toolkit (OAT) for Asia Pacific national malaria control programs

Is a radical cure enough? Assessing a primaquine treatment for adult males in Cambodia to eliminate vivax malaria by 2025

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