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Malar J. 2017 Apr 5;16(1):141. doi: 10.1186/s12936-017-1784-1.

Challenges for achieving safe and effective radical cure of Plasmodium vivax: a round table discussion of the APMEN Vivax Working Group.

Author information

1
Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia. kamala.ley-thriemer@menzies.edu.au.
2
Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia.
3
National Vector Borne Disease Control Programme, Honiara, Solomon Islands.
4
National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia.
5
School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia.
6
International Centre for Diarrheal Diseases and Research, Dhaka, Bangladesh.
7
Department of Pediatrics, Medical Faculty, University of Sumatera Utara, Medan, Indonesia.
8
Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangok, Thailand.
9
Medicines for Malaria Venture (MMV), Geneva, Switzerland.
10
Diagnostics Program, PATH, Seattle, USA.
11
Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangok, Thailand.
12
Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
13
Ministry of Health and Family Welfare, Malaria and Parasitic Disease Control, Director General of Health Services, Mohakhali, Dhaka, Bangladesh.
14
Vector-borne Disease Control Programme (VDCP), Department of Public Health, Ministry of Health in Bhutan, Thimphu, Bhutan.
15
National Vector Borne Disease Control Programme Directorate General of Health Services Ministry of Health & Family Welfare, New Delhi, India.
16
National Malaria Control Program, Jakarta, Indonesia.
17
National Center for Entomology Parasitology and Malaria Control, Vientiane, Laos.
18
Vector-borne Diseases Control Programme, Ministry of Health Malaysia, Kuala Lumpur, Malaysia.
19
Malaria Control Programme, Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal.
20
National Malaria Control Programme, Goroka, Papua New Guinea.
21
Malaria Control Programme, Department of Health, Manila, Philippines.
22
Division of Malaria & Parasitic Diseases, Korea Centers for Disease Control and Prevention, Seoul, South Korea.
23
Antimalaria Campaign, Ministry of Health, Colombo, Sri Lanka.
24
Bureau of Vector-Borne Disease, Department of Disease Control, Ministry of Public Health, Bangkok, Thailand.
25
National Malaria Control Programme, Port Vila, Vanuatu.
26
National Institute of Malaria, Parasitology, and Entomology (NIMPE), Tam Kỳ, Vietnam.
27
Access Bio Inc, Monmouth, USA.
28
Australian Army Malaria Institute, Enoggera, QLD, Australia.
29
Centre for Biomedical Research, Burnet Institute, Melbourne, Australia.
30
Vector Borne Disease Control, Ministry of Health, Jakarta, Indonesia.
31
Indonesian Parasitic Association, Jakarta, Indonesia.
32
Eijkman Institute of Molecular Biology, Jakarta, Indonesia.
33
FIND, Geneva, Switzerland.
34
Jiangsu Institute of Parasitic Diseases, Wuxi, China.
35
Karolinska Institutet, Stockholm, Sweden.
36
Osaka City University, Osaka, Japan.
37
Centre for Genomics and Global Health, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK.
38
Wellcome Trust Sanger Institute, Hinxton, UK.
39
Department of Molecular Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Salaya, Thailand.
40
Malaria Atlas Project, Nuffield Department of Medicine, Oxford Big Data Institute, University of Oxford, Oxford, UK.
41
Malaria Consortium, London, UK.
42
Model Rural Health Research Unit (MRHRU), Tripura State, ICMR, Agartala, India.
43
Yayasan Pengembangan Kesehatan dan Masyarakat Papua Timika, Timika, Indonesia.
44
The Research Institute for Tropical Medicine, Manila, Philippines.
45
The Walter + Eliza Hall Institute of Medical Research, Melbourne, Australia.
46
Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.
47
President's Malaria Initiative, United States Agency for International Development, Bangkok, Thailand.
48
World Health Organization Western Pacific Region, Manila, Philippines.
49
WWARN, Oxford, UK.
50
University of Washington, Seattle, WA, USA.
51
QIMR Berghofer Medical Research Institute, Brisbane, Australia.
52
Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.

Abstract

The delivery of safe and effective radical cure for Plasmodium vivax is one of the greatest challenges for achieving malaria elimination from the Asia-Pacific by 2030. During the annual meeting of the Asia Pacific Malaria Elimination Network Vivax Working Group in October 2016, a round table discussion was held to discuss the programmatic issues hindering the widespread use of primaquine (PQ) radical cure. Participants included 73 representatives from 16 partner countries and 33 institutional partners and other research institutes. In this meeting report, the key discussion points are presented and grouped into five themes: (i) current barriers for glucose-6-phosphate deficiency (G6PD) testing prior to PQ radical cure, (ii) necessary properties of G6PD tests for wide scale deployment, (iii) the promotion of G6PD testing, (iv) improving adherence to PQ regimens and (v) the challenges for future tafenoquine (TQ) roll out. Robust point of care (PoC) G6PD tests are needed, which are suitable and cost-effective for clinical settings with limited infrastructure. An affordable and competitive test price is needed, accompanied by sustainable funding for the product with appropriate training of healthcare staff, and robust quality control and assurance processes. In the absence of quantitative PoC G6PD tests, G6PD status can be gauged with qualitative diagnostics, however none of the available tests is currently sensitive enough to guide TQ treatment. TQ introduction will require overcoming additional challenges including the management of severely and intermediately G6PD deficient individuals. Robust strategies are needed to ensure that effective treatment practices can be deployed widely, and these should ensure that the caveats are outweighed by  the benefits of radical cure for both the patients and the community. Widespread access to quality controlled G6PD testing will be critical.

KEYWORDS:

APMEN; P. vivax; Primaquine; Radical cure; Tafenoquine; Vivax malaria

PMID:
28381261
PMCID:
PMC5382417
DOI:
10.1186/s12936-017-1784-1
[Indexed for MEDLINE]
Free PMC Article

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