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. 2024 Jun 5;18(6):e0012197.
doi: 10.1371/journal.pntd.0012197. eCollection 2024 Jun.

Perspectives of healthcare professionals on training for quantitative G6PD testing during implementation of tafenoquine in Brazil (QualiTRuST Study)

Alicia Santos  1   2 , Marcelo Brito  1 , Evellyn Silva  1   2 , Felipe Rocha  1 , Ana Oliveira  1 , Rafaela Dávila  1   2 , Hiran Gama  1   2 , Jéssica Albuquerque  1 , Mena Paiva  1   2 , Djane Baía-Silva  1   2 , Vanderson Sampaio  1   2 , Patrícia Balieiro  1   2 , Rosilene Rufatto  3 , Penny Grewal Daumerie  4 , Cássio Peterka  5 , Francisco Edilson Lima Jr  5 , Wuelton Monteiro  1   2 , Ana Arcanjo  6 , Ricardo Silva  6 , Dhelio Batista Pereira  3 , Marcus Lacerda  1   2   7   8 , Felipe Murta  1   2   7
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Perspectives of healthcare professionals on training for quantitative G6PD testing during implementation of tafenoquine in Brazil (QualiTRuST Study)

Alicia Santos et al. PLoS Negl Trop Dis. .

Abstract

Effective radical cure of Plasmodium vivax malaria is essential for malaria elimination in Brazil. P. vivax radical cure requires administration of a schizonticide, such as chloroquine, plus an 8-aminoquinoline. However, 8-aminoquinolines cause hemolysis in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, requiring prior screening to exclude those at risk. Brazil is pioneering the implementation of tafenoquine, a single-dose 8-aminoquinoline indicated for P. vivax patients with >70% of normal G6PD activity. Tafenoquine implementation in Manaus and Porto Velho, two municipalities located in the western Brazilian Amazon, included comprehensive training of healthcare professionals (HCPs) on point-of-care quantitative G6PD testing and a new treatment algorithm for P. vivax radical cure incorporating tafenoquine. Training was initially provided to higher-level facilities (phase one) and later adapted for primary care units (phase two). This study analyzed HCP experiences during training and implementation and identified barriers and facilitators. In-depth interviews and focus discussion groups were conducted 30 days after each training for a purposive random sample of 115 HCPs. Thematic analysis was employed using MAXQDA software, analyzing data through inductive and deductive coding. Analysis showed that following the initial training for higher-level facilities, some HCPs did not feel confident performing quantitative G6PD testing and prescribing the tafenoquine regimen. Modifications to the training in phase two resulted in an improvement in understanding the implementation process of the G6PD test and tafenoquine, as well as in the knowledge acquired by HCPs. Additionally, knowledge gaps were addressed through in situ training, peer communication via a messaging app, and educational materials. Training supported effective deployment of the new tools in Manaus and Porto Velho and increased awareness of the need for pharmacovigilance. A training approach for nationwide implementation of these tools was devised. Implementing quantitative G6PD testing and tafenoquine represents a significant shift in P. vivax malaria case management. Consistent engagement with HCPs is needed to overcome challenges in fully integrating these tools within the Brazilian health system.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: PGD is employed by Medicines for Malaria Venture and CP and FEL Jr are employed by the Brazilian Ministry of Health.

Figures

Fig 1
Fig 1. Timeline of training and qualitative data collection periods during the implementation process.
F. Murta, created in Canva.
Fig 2
Fig 2. New treatment algorithm adopted in Manaus and Porto Velho municipalities during the implementation of quantitative G6PD testing and tafenoquine.
Fig 3
Fig 3. Proposed training approach for future training in the implementation of tafenoquine and the quantitative G6PD test, based on the feedback from HCPs.
F. Murta, created in Canva.
See this image and copyright information in PMC

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