Implementing radical cure diagnostics for malaria: User perspectives on G6PD testing in Bangladesh

Nora Engel, Cristian Ghergu, Mohammad Abdul Matin, Mohammad Golam Kibria, Kamala Thriemer, Ric N. Price, Xavier C. Ding, Rosalind E. Howes, Benedikt Ley, Sandra Incardona, Mohammad Shafiul Alam

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Background: The radical cure of Plasmodium vivax requires treatment with an 8-aminoquinoline drug, such as primaquine and tafenoquine, to eradicate liver hypnozoite stages, which can reactivate to cause relapsing infections. Safe treatment regimens require prior screening of patients for glucose-6-phosphate dehydrogenase (G6PD) deficiency to avoid potential life-threatening drug induced haemolysis. Testing is rarely available in malaria endemic countries, but will be needed to support routine use of radical cure. This study investigates end-user perspectives in Bangladesh on the introduction of a quantitative G6PD test (SD Biosensor STANDARD™ G6PD analyser) to support malaria elimination. 

Methods: The perspectives of users on the SD Biosensor test were analysed using semi-structured interviews and focus group discussions with health care providers and malaria programme officers in Bangladesh. Key emerging themes regarding the feasibility of introducing this test into routine practice, including perceived barriers, were analysed.

Results: In total 63 participants were interviewed. Participants emphasized the life-saving potential of the biosensor, but raised concerns including the impact of limited staff time, high workload and some technical aspects of the device. Participants highlighted that there are both too few and too many P. vivax patients to implement G6PD testing owing to challenges of funding, workload and complex testing infrastructure. Implementing the biosensor would require flexibility and improvisation to deal with remote sites, overcoming a low index of suspicion and mutual interplay of declining patient numbers and reluctance to test. This approach would generate new forms of evidence to justify introduction in policy and carefully consider questions of deployment given declining patient numbers. 

Conclusions: The results of the study show that, in an elimination context, the importance of malaria needs to be maintained for both policy makers and the affected communities, in this case by ensuring P. vivax, PQ treatment, and G6PD deficiency remain visible. Availability of new technologies, such as the biosensor, will fuel ongoing debates about priorities for allocating resources that must be adapted to a constantly evolving target. Technical and logistical concerns regarding the biosensor should be addressed by future product designs, adequate training, strengthened supply chains, and careful planning of communication, advocacy and staff interactions at all health system levels.

Original languageEnglish
Article number217
Pages (from-to)1-12
Number of pages12
JournalMalaria Journal
Issue number1
Publication statusPublished - 12 May 2021

Bibliographical note

Funding Information:
We would like to thank all participants for their time and insights provided for this study. We acknowledge the support of the National Malaria Elimination Programme of Bangladesh to conduct this study. icddr,b is also grateful to the Governments of Bangladesh, Canada, Sweden and the UK for providing core/unrestricted support.

Funding Information:
This study was funded by a grant from the Australian government to FIND and supported by a regional collaborations programme grant by the Australian Academy of Science and the Asia Pacific Malaria Elimination Network funding by the Bill and Melinda Gates Foundation (INV-010504). BL is funded by the Australian Department of Foreign Affairs and Trade, RNP is funded by the Wellcome Trust (Senior Fellowship in Clinical Science, 200909), KT is a CSL Centenary Fellow. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright:
© 2021, The Author(s).

Copyright 2021 Elsevier B.V., All rights reserved.


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