APMEN Vivax Working Group Virtual Update 2023
The Asia Pacific Malaria Elimination Network (APMEN) Vivax Working Group organized their annual meeting as a virtual update on 7th and 8th November 2023. Supported by MMV, the zoom meeting allowed national malaria programs (NMPs), experts, researchers, civil society organizations, and stakeholders from around the world to come together despite geographical barriers.
Altogether, 173 participants from 31 countries joined the two-day meeting. The agenda and discussions were shaped by outcomes from the previous work of the group, specifically focusing on the key priorities identified by NMPs from the Asia Pacific region.
The objectives of the meeting were to:
- Explore the latest on P. vivax malaria research and development in terms of diagnosis and treatment
- Provide an update on APMEN VxWG activities, and explore elements of health system strengthening for improved malaria case management
Dr. Neena Valecha, the chair of APMEN VxWG, welcomed the participants, outlined the objectives, and gave an overview of the meeting agenda.
Key Sessions and Discussions:
The meeting gave participants the opportunity to delve deeper into topics critical to the elimination of P. vivax malaria in the Asia Pacific region.
G6PD Diagnosis:
The session featured two presentations and a commentary followed by interactive questions and answers. The first presentation by Dr Aungkana Sajaeng outlined how Thailand is integrating G6PD testing in the patient pathways at different levels of health facilities for malaria case management. Dr Leanne Robinson then presented the possible use cases of P. vivax serology in elimination settings.
Treatment:
The session on radical cure included the latest updates on primaquine and tafenoquine from MMV, and a quickfire update on different studies and approaches to radical cure from Thailand, Suriname and PNG, as well as tafenoquine use as prophylaxis. Results from the PRIMA study were then shared, showing that high daily dose primaquine (PQ7) was relatively well tolerated[1] and reduced the risk of P. vivax parasitaemia in patients presenting with P. falciparum malaria. This was followed by a reflection on the study results from Dr Hammad Habib from the NMP in Pakistan.
APMEN VxWG updates:
The workplan and the activities of APMEN VxWG were shared in this session, along with the progress made in Pakistan after the readiness planning activity in 2022. The upcoming G6PD pilot project was presented which is expected to provide field experience of using point-of-care G6PD testing in Pakistan. In addition, healthcare worker training which was one of the top NMP priorities was discussed in detail.
Dr. Caroline Lynch, the co-chair of APMEN VxWG underlined the need for improved training during her presentation:
“The cascade training can be too didactic and not very participative because there is a lot of time pressure on NMPs and lots of competing priorities. So, defaulting back to traditional didactic training ends up being more of a briefing rather than a transfer of knowledge.”
“We’re also missing some key quality benchmarks that are needed, for example – pre and post-training competency assessments. At the moment, indicators are often ‘did the training take place or how many people were trained’, as opposed to ‘what proportions of the participants achieved over 85% in the post-training competency’.”
The impact of health system elements on malaria:
In this last session, there were presentations on the Global Fund’s pooled procurement mechanisms, community-led initiatives for vivax malaria from the GMS CSO platform, and the importance of integrating pharmacovigilance systems in public health programmes (including malaria).
The meeting was closed by Amita Chebbi, Executive Vice President, Advocacy and Programs for the Asia Pacific Leaders Malaria Alliance and Asia Pacific Malaria Elimination Network. She remarked:
“The work of VxWG is more critical than ever as half the malaria burden in the region is vivax. And we know that we're not going to get to the 2030 elimination goal without a strong push on vivax elimination. The work of VxWG has really evolved over the last few years from building an evidence base for radical cure to now really going further along that continuum and looking at ways to support the catalyzing of policy change and ensuring the health systems are ready to incorporate radical cure into their national strategies.”
[1] Increased gastrointestinal symptoms have been reported with higher daily doses of primaquine in previous trials, but tolerability can be mitigated by ingestion of primaquine with food. Patients in the PRIMA trial were explicitly advised to take their medication with food such as crackers, biscuits, or bananas and these were provided by study staff. All but seven of the 1667 primaquine doses in the intervention arm were taken with food and were generally well tolerated. See https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01553-2/fulltext for full details of the PRIMA study.