4 research outputs found
Quantifying primaquine effectiveness and improving adherence: a round table discussion of the APMEN Vivax Working Group
The goal to eliminate malaria from the Asia-Pacific by 2030
will require the safe and widespread delivery of effective
radical cure of malaria. In October 2017, the Asia Pacific
Malaria Elimination Network Vivax Working Group met to discuss
the impediments to primaquine (PQ) radical cure, how these can
be overcome and the methodological difficulties in assessing
clinical effectiveness of radical cure. The salient discussions
of this meeting which involved 110 representatives from 18
partner countries and 21 institutional partner organizations are
reported. Context specific strategies to improve adherence are
needed to increase understanding and awareness of PQ within
affected communities; these must include education and health
promotion programs. Lessons learned from other disease programs
highlight that a package of approaches has the greatest
potential to change patient and prescriber habits, however
optimizing the components of this approach and quantifying their
effectiveness is challenging. In a trial setting, the reactivity
of participants results in patients altering their behaviour and
creates inherent bias. Although bias can be reduced by
integrating data collection into the routine health care and
surveillance systems, this comes at a cost of decreasing the
detection of clinical outcomes. Measuring adherence and the
factors that relate to it, also requires an in-depth
understanding of the context and the underlying sociocultural
logic that supports it. Reaching the elimination goal will
require innovative approaches to improve radical cure for vivax
malaria, as well as the methods to evaluate its effectiveness
G6PD testing in support of treatment and elimination of malaria: recommendations for evaluation of G6PD tests
Malaria elimination will be possible only with serious attempts to address asymptomatic infection and chronic infection by both Plasmodium falciparum and Plasmodium vivax. Currently available drugs that can completely clear a human of P. vivax (known as “radical cure”), and that can reduce transmission of malaria parasites, are those in the 8-aminoquinoline drug family, such as primaquine. Unfortunately, people with glucose-6-phosphate dehydrogenase (G6PD) deficiency risk having severe adverse reactions if exposed to these drugs at certain doses. G6PD deficiency is the most common human enzyme defect, affecting approximately 400 million people worldwide. Scaling up radical cure regimens will require testing for G6PD deficiency, at two levels: 1) the individual level to ensure safe case management, and 2) the population level to understand the risk in the local population to guide Plasmodium vivax treatment policy. Several technical and operational knowledge gaps must be addressed to expand access to G6PD deficiency testing and to ensure that a patient’s G6PD status is known before deciding to administer an 8-aminoquinoline-based drug.
In this report from a stakeholder meeting held in Thailand on October 4 and 5, 2012, G6PD testing in support of radical cure is discussed in detail. The focus is on challenges to the development and evaluation of G6PD diagnostic tests, and on challenges related to the operational aspects of implementing G6PD testing in support of radical cure. The report also describes recommendations for evaluation of diagnostic tests for G6PD deficiency in support of radical cure
Quantifying primaquine effectiveness and improving adherence: a round table discussion of the APMEN Vivax Working Group
The goal to eliminate malaria from the Asia-Pacific by 2030
will require the safe and widespread delivery of effective
radical cure of malaria. In October 2017, the Asia Pacific
Malaria Elimination Network Vivax Working Group met to discuss
the impediments to primaquine (PQ) radical cure, how these can
be overcome and the methodological difficulties in assessing
clinical effectiveness of radical cure. The salient discussions
of this meeting which involved 110 representatives from 18
partner countries and 21 institutional partner organizations are
reported. Context specific strategies to improve adherence are
needed to increase understanding and awareness of PQ within
affected communities; these must include education and health
promotion programs. Lessons learned from other disease programs
highlight that a package of approaches has the greatest
potential to change patient and prescriber habits, however
optimizing the components of this approach and quantifying their
effectiveness is challenging. In a trial setting, the reactivity
of participants results in patients altering their behaviour and
creates inherent bias. Although bias can be reduced by
integrating data collection into the routine health care and
surveillance systems, this comes at a cost of decreasing the
detection of clinical outcomes. Measuring adherence and the
factors that relate to it, also requires an in-depth
understanding of the context and the underlying sociocultural
logic that supports it. Reaching the elimination goal will
require innovative approaches to improve radical cure for vivax
malaria, as well as the methods to evaluate its effectiveness