Regional initiatives and evidence-generation efforts to eliminate P. vivax malaria in Latin America

The 2022 PAVE Regional Meeting took place virtually on 8th November and brought together more than 100 participants representing research institutions, funders, the Pan American Health Organization (PAHO), international organizations and ministries of health from several Latin American countries, including Brazil, Colombia, Guatemala, Honduras, Panama, and Peru—all of whom are actively working to address the malaria burden in the Americas. The meeting was an opportunity to share some of the innovative approaches being used in the region to support P. vivax elimination. 

For the past two years, the PAVE Regional Meeting has helped catalyze country-to-country exchanges, and promote coordination with regional and global partners working on P. vivax elimination in the Americas. This year, the event shone a spotlight on the real-world evidence-generation efforts of PAVE in key countries and how these findings may inform policy change.

• Brazil: The Tafenoquine Rollout STudy (TRuST) concluded patient enrolment at the end of August 2022. The study aimed to assess the feasibility of providing appropriate radical cure treatment (including either primaquine or tafenoquine) based on the results of glucose-6-phosphate dehydrogenase (G6PD) testing. Dr. Dhelio Pereira, TRuST co-principal investigator and director of Clinical Research at the Center of Research in Tropical Medicine (CEPEM), together with the deputy director of the Immunization and Communicable Diseases Department of the Brazilian Ministry of Health, Cássio Peterka, presented the study's phase I results and key findings from the interim analysis. They highlighted that the G6PD test improved safety for using tafenoquine and for choosing the appropriate therapeutic regimen of primaquine at both higher- and lower-level facilities. Study lead Dr. Felipe Murta of Dr Heitor Vieira Dourado Tropical Medicine Foundation (FMT-HVD) presented the key findings of QualiTRuST. QualiTRuST is a qualitative research study for TRuST focusing on understanding the acceptability of introducing these new tools for health workers and patients. Dr. Murta highlighted the importance of training and practice for health workers to increase their confidence in using the G6PD test. PAVE presented an overview of results from the health economic assessments (HEAs) to assess the potential incorporation of new radical cure tools into the Brazilian health system during the meeting; these results are in the final stages of validation by the Ministry of Health.
   
• Colombia: The researcher Lina Zuluaga presented the G6PD testing Pilot Educational Program (PEP), led by the malaria group from Universidad de Antioquia. The PEP’s objective is to evaluate a training methodology for health professionals involved in malaria diagnosis in Colombia to adequately perform G6PD testing with a quantitative device. The study team has implemented all four of the PEP’s pilot workshops with potential test users, completing data collection. The University of Antioquia also completed HEAs in Colombia. The assessments explore the cost-effectiveness and budget impact of various radical cure treatments following G6PD testing. Presented by Viviana Velez, a researcher at the University of Antioquia, the HEA final results are expected in the coming months.
   
• Peru: Dr. Alejandro Llanos from the Universidad Peruana Cayetano Heredia (UPCH) is leading a team of researchers to implement an operational feasibility study of P. vivax malaria radical cure after G6PD testing in medium and higher-level health facilities. The study will assess the introduction of tafenoquine with G6PD testing in real-world settings and, in so doing, aims to provide evidence to support the national malaria elimination strategy. Study implementation will begin in early 2023. 

The 2022 Regional Meeting also featured experiences from countries addressing the needs of special populations at high risk of malaria. Representatives from French Guiana, Honduras, and Peru shared their strategies to overcome the challenges hard-to-reach communities face in accessing quality, timely diagnosis, treatment, and care. 
 

• French Guiana: Dr. Yann Lambert, from the Centre Hospitalier de Cayenne, presented the Malakit, and planned CUREMA projects. Malakit was a pilot package that included the distribution of malaria self-diagnosis and self-treatment kits to workers in illegal gold mines who are at high risk for malaria infection. The radical CURE for Malaria among highly mobile and hard-to-reach populations in the Guyanese Shield (CUREMA) project, aims to build on Malakit by adding radical cure treatment for P. vivax with G6PD testing to significantly reduce the parasite reservoir and thus malaria transmission in remote forested areas.
   
• Honduras: Migration is one of the most important drivers of malaria transmission in Honduras. Dr. Lorenzo Pavon, from the Health Surveillance Unit of the Ministry of Health, shared the challenges faced in implementing a malaria intervention across borders. He highlighted the need for a holistic and coordinated approach between neighbouring countries to monitor cross-border malaria infections and to ensure the most affected populations are reached.
   
• Peru: Dr Alejandro Llanos, from UPCH, presented a project to implement focalized mass drug administration (fMDA) for P. vivax malaria with TQ in a malaria-endemic area of Loreto, Peru. The objective of the study is to determine the effectiveness of fMDA in reducing P. vivax malaria transmission, as well as its safety, tolerability and feasibility. The project is expected to begin early 2023.

The importance of regional coordination to reach malaria elimination was highlighted during the meeting. Dr. Roberto Montoya, PAHO’s Malaria Advisor, expressed PAHO’s commitment to launch a regional radical cure working group. The mechanism is aimed at supporting countries to gather and analyze evidence, identify gaps and ultimately, formulate and implement policies for P. vivax radical cure.

About PAVE
The Partnership for Vivax Elimination (PAVE) is led by Medicines for Malaria Venture (MMV) and PATH. It facilitates access to new and existing malaria diagnostics and treatments for P. vivax elimination, supporting countries in adopting new and existing tools and approaches to achieve universal access to the best clinical practices for P. vivax case management.