G6PD testing and radical cure for Plasmodium vivax in Cambodia: A mixed methods implementation study

Area of Science:

• Global Health
• Infectious Diseases
• Parasitology

Background:

• Plasmodium vivax (P.v) malaria poses challenges to Cambodia's 2025 elimination goal.
• Glucose-6-phosphate dehydrogenase (G6PD) deficiency limits radical cure options due to haemolysis risk.
• Recurrent P.v relapses cause significant health and socioeconomic burdens.

Purpose of the Study:

• To design, implement, and evaluate a novel care pathway for P.v radical cure.
• To address challenges posed by G6PD deficiency in P.v treatment.
• To facilitate the safe and effective use of 8-aminoquinolones for P.v radical cure.

Main Methods:

• Co-developed a care pathway with national and local stakeholders in Pursat, Cambodia.
• Employed mixed methods, including quantitative data and qualitative interviews, for evaluation.
• Assessed intervention feasibility through uptake, adherence, and acceptability metrics.

Main Results:

• A new care pathway was implemented, integrating point-of-care G6PD testing and primaquine treatment.
• High rates of G6PD testing (626 adults) and primaquine initiation (98.8% for normal G6PD, 50.8% for deficient G6PD) were achieved.
• The pathway demonstrated high acceptability and adherence, with no severe adverse events reported.

Conclusions:

• The developed care pathway is feasible, with high uptake, adherence, and acceptability for P.v radical cure in Cambodia.
• Supporting interventions and a phased implementation were crucial for success.
• The successful pathway implementation advances Cambodia's malaria elimination efforts.