Highlights from the Partnership for Vivax Elimination (PAVE) Greater Mekong Subregion (GMS) Country Coordinator Experience Exchange

From 25th - 27th April 2022, PAVE Country Coordinators from the GMS, together with some APMEN Vivax Working Group (VxWG) team members met for their first in-person meeting since the start of the pandemic. The PAVE Country Coordinators for the GMS are the Clinton Health Access Initiative (CHAI) for Cambodia and Lao PDR; PATH for Vietnam; PSI and PATH for Myanmar and Dr Chansuda Wongsrichanalai for MMV in Thailand.  The aim of the meeting was to ensure the quality and effectiveness of PAVE’s work by sharing best practices and research findings; holding in-depth discussions on training and implementation of point-of-care (POC) G6PD testing and undergoing joint training on the use of the SD Biosensor G6PD test to strengthen the team’s technical advocacy capacity. 

There was a lot of information and best practice sharing to cover, as since the last in-person meeting, PAVE Country Coordinators (CCs) have successfully,  

• supported National Malaria Programmes (NMPs) in developing and implementing training on point-of-care (POC) G6PD testing for roll-out in Cambodia, Lao PDR, and Thailand; 
• developed materials to support improved use of current P. vivax radical cure treatments in Myanmar; 
• led a G6PD operational research study in Vietnam and created G6PD test training materials; 
• piloted patient adherence and referral interventions in Cambodia and Lao PDR; and  
• sought to improve coordination with national pharmacovigilance units in Myanmar and Cambodia.   

The first day of the meeting started with a training session on the SD Biosensor G6PD test facilitated by Dr Aungkana Saejang, Head of diagnostics within the Thai Ministry of Public Health’s Division of Vector Borne Diseases (DVBD), Sarinee Srithep from the Chiang Mai Diagnostics division of the Office of Disease Prevention and Control for the Ministry of Public Health, Thailand and PATH-Vietnam. Country coordinators and the facilitators shared lessons, and identified common challenges encountered as part of the roll-out of G6PD tests in their respective countries.  

Following the training, the PAVE team shared experiences in strengthening referrals for G6PD testing; improving coordination for better pharmacovigilance between NMPs and pharmacovigilance units and discussed what mechanisms they have used both to measure and to improve patient adherence across the subregion. The session on pharmacovigilance led to an agreement to host a follow up session with PAVE Country Coordinators, National Malaria Programmes, the Australian Therapeutic Goods Agency (TGA) and pharmacovigilance unit focal points demonstrating how the WHO’s VigiBase pharmacovigilance database system works. 

Experts from the Australian Therapeutic Goods Agency (TGA) presented on pharmacovigilance systems and the PAVE teams discussed how these may be improved in their respective countries.  Dr Karma Lhazeen, Chair of the APMEN VxWG gave a keynote talk on managing expectations around vivax elimination and provided examples of the challenges faced in finally eliminating vivax malaria from Bhutan.  

There was a session providing updates on planned and ongoing studies for new vivax tools. Dr Kamala Thriemer from Menzies presented the EFFORT study protocol. Penny Grewal from MMV presented the phase I results from the Brazil TRuST study as well as the planned approach for the Unitaid-supported feasibility studies examining the feasibility, acceptability, and cost implications of providing primaquine or single-dose tafenoquine after G6PD testing in real-world settings in priority countries. Spike Nowak from PATH presented an update on the product development pipeline for higher sensitivity RDTs for P. vivax. 

PAVE Country coordinators will continue to liaise closely with National Malaria Programmes to support them in achieving their malaria elimination goals.