The Pilot Educational Program (PEP): G6PD Test Training for Health Workers in Colombia
The importance of being able to determine the G6PD status of a patient with P. vivax malaria has risen over recent years with increasing awareness of the contribution of relapse to disease burden. 8-aminoquinoline drugs such as primaquine and tafenoquine that are used to prevent P. vivax relapse can cause haemolysis in patients who are deficient in a specific enzyme called glucose-6-phosphate-dehydrogenase (G6PD). G6PD deficiency is a common hereditary condition and given this risk, World Health Organization (WHO) guidelines state that “the G6PD status of patients should be used to guide administration of primaquine for preventing relapse” of P. vivax malaria. For tafenoquine, quantitative G6PD testing prior to its administration is required per the product regulatory approval.
Until recently, testing for G6PD deficiency has been limited by a lack of reliable, quantitative tests that can be used in remote settings where many malaria patients seek care. This is now changing with the availability of the STANDARDTM G6PD, quantitative, point-of-care test co-developed by PATH and SD Biosensor.
About the Pilot Educational Program (PEP)
In 2022, the University of Antioquia’s Malaria Group rolled out a Pilot Educational Program (PEP) in Colombia, funded by PAVE, and supported by the Colombian Ministry of Health. It aimed at developing and testing a training methodology for health professionals and community health workers on the use of the rapid, quantitative, point-of-care STANDARDTM G6PD test.
The program was conceived in response to the Colombian Ministry of Health’s interest in determining whether a training methodology could enable health professionals and community agents to reliably perform G6PD testing as part of P. vivax case management. The program sought to validate the training methodology, evaluate the usability and acceptability of this test by health workers, and to understand at what levels of the health system the test could be used.
Once the methodology and materials were developed, the University of Antioquia held four workshops of two-day duration to roll-out and evaluate the PEP in four malaria-endemic settings. The workshops were held in the municipalities of Quibdó (Chocó), Leticia (Amazonas), El Bagre and Turbo (Antioquia) from October to November 2022.
Key Findings
Through the PEP, an effective and replicable training methodology was developed and tested to integrate G6PD testing into P. vivax case management in Colombia. During the workshops, participants significantly improved their understanding of why, when and how to test for G6PD deficiency. The PEP team identified barriers and facilitators to G6PD testing within the complex context of the Colombian health system, and developed a comprehensive ‘Toolbox’ that can support policy makers seeking to adopt G6PD testing in routine practice in and outside of Colombia.
The Toolbox includes materials that were developed to be used during the workshops (and that could be used to replicate the workshops) and additional materials that would be required for real-world implementation of this training program. There are materials targeted for health workers and community agents and for patients receiving care. These materials were adjusted based on the lessons learned during the workshops and input from participants.
Next Steps
A pilot implementation of G6PD testing in four health facilities started in September 2023 in Colombia. The pilot will generate real-world evidence to inform policy decisions on the routine use of G6PD testing in P. vivax malaria treatment. This training used the PEP’s validated methodology and materials.