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Review
. 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

Kamala Thriemer  1 , Benedikt Ley  2 , Albino Bobogare  3 , Lek Dysoley  4   5 , Mohammad Shafiul Alam  6 , Ayodhia P Pasaribu  7 , Jetsumon Sattabongkot  8 , Elodie Jambert  9 , Gonzalo J Domingo  10 , Robert Commons  2 , Sarah Auburn  2 , Jutta Marfurt  2 , Angela Devine  11   12 , Mohammad M Aktaruzzaman  13 , Nayeem Sohel  13 , Rinzin Namgay  14 , Tobgyel Drukpa  14 , Surender Nath Sharma  15 , Elvieda Sarawati  16 , Iriani Samad  16 , Minerva Theodora  16 , Simone Nambanya  17 , Sonesay Ounekham  18 , Rose Nanti Binti Mudin  18 , Garib Da Thakur  19 , Leo Sora Makita  20 , Raffy Deray  21 , Sang-Eun Lee  22 , Leonard Boaz  3 , Manjula N Danansuriya  23 , Santha D Mudiyanselage  23 , Nipon Chinanonwait  24 , Suravadee Kitchakarn  24 , Johnny Nausien  25 , Esau Naket  25 , Thang Ngo Duc  26 , Ha Do Manh  26 , Young S Hong  27 , Qin Cheng  28 , Jack S Richards  29 , Rita Kusriastuti  30   31 , Ari Satyagraha  32 , Rintis Noviyanti  32 , Xavier C Ding  33 , Wasif Ali Khan  6 , Ching Swe Phru  6 , Zhu Guoding  34 , Gao Qi  34 , Akira Kaneko  35   36 , Olivo Miotto  11   37   38 , Wang Nguitragool  39 , Wanlapa Roobsoong  8 , Katherine Battle  40 , Rosalind E Howes  40 , Arantxa Roca-Feltrer  41 , Stephan Duparc  9 , Ipsita Pal Bhowmick  42 , Enny Kenangalem  43 , Jo-Anne Bibit  44 , Alyssa Barry  45   46 , David Sintasath  47 , Rabindra Abeyasinghe  48 , Carol H Sibley  49   50 , James McCarthy  51 , Lorenz von Seidlein  11 , J Kevin Baird  12   52 , Ric N Price  2   12
Affiliations
Review

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

Kamala Thriemer et al. Malar J. .

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.

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