Abstract
BackgroundWide-spread implementation of treatment regimens for the radical cure of vivax malaria is hindered by a range of factors. This has resulted in an increase in the relative proportion of vivax malaria and is an important obstacle in the achievement of global malaria elimination by 2030. The main objective of this study was to explore the current policies guiding the treatment plans on vivax malaria, and the factors affecting the implementation of radical cure in South/South East Asian and Asian Pacific countries.MethodsThis was a qualitative study among respondents who represented national malaria control programmes (NMCPs) or had a role and influence in the national malaria policies. 33 respondents from 17 countries in South/South East Asia and Asia Pacific participated in interviews between October 15 and December 15, 2020. Semi-structured interviews were conducted virtually except for two face to face interviews and audio-recorded. Transcribed audio-records underwent thematic analysis using QSR NVivo.ResultsPolicies against vivax malaria were underprioritized, compared with the focus on falciparum malaria and, in particular, drug resistant Plasmodium falciparum strains. Despite the familiarity with primaquine (PQ) as the essential treatment to achieve the radical cure, the respondents contested the need for G6PD testing. Optional G6PD testing was reported to have poor adherence. The fear of adverse events led health workers to hesitate prescribing PQ. In countries where G6PD was mandatory, respondents experienced frequent stockouts of G6PD rapid diagnostic kits in peripheral health facilities, which was compounded by a short shelf life of these tests. These challenges were echoed across participating countries to various degrees. Most respondents agreed that a shorter treatment regimen, such as single dose tafenoquine could resolve these problems but mandatory G6PD testing will be needed. The recommendation of shorter regimens including tafenoquine or high dose PQ requires operational evidence demonstrating the robust performance of point of care G6PD tests (biosensors).ConclusionThere was sparse implementation and low adherence to the radical cure in South/South East Asian and Asian pacific countries. Shorter treatment regimens with appropriate point of care quantitative G6PD tests may resolve the current challenges. Operational evidence on point of care quantitative G6PD tests that includes the feasibility of integrating such tests into the radical cure regimen are critical to ensure its implementation.
Highlights
Wide-spread implementation of treatment regimens for the radical cure of vivax malaria is hindered by a range of factors
Study context Policymakers and stakeholders from 17 countries were interviewed starting with questions regarding the two fundamental aspects of vivax malaria treatment regimen, Glucose 6 phosphate dehydrogenase (G6PD) testing for routine treatment of vivax malaria (Fig. 1) and the radical cure regimens use in the country of the respondent (Fig. 2)
In six countries (India, Myanmar, Nepal, Philippines, Thailand, and Vietnam), G6PD testing was not mandatory and PQ was provided with clinical supervision and follow-up
Summary
Wide-spread implementation of treatment regimens for the radical cure of vivax malaria is hindered by a range of factors This has resulted in an increase in the relative proportion of vivax malaria and is an important obstacle in the achievement of global malaria elimination by 2030. Funding has been made available for novel tools such as mass drug administration, increased community engagement and strategies to target remote and at-risk populations such as pregnant women, children, forest goers and migrant populations [3,4,5,6,7,8,9] These intensive efforts have resulted in a significant decline in falciparum malaria, but with a lower impact on Plasmodium vivax infections [10,11,12,13,14]. The treatment of both schizonts and hypnozoites to prevent relapse is referred to as the radical cure [17]
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