Piloting the options assessment toolkit with national malaria programme leaders from the Asia-Pacific countries: a...

Plasmodium vivax malaria remains a major challenge in the Asia-Pacific region, where National Malaria Programmes (NMPs) will need to determine optimal radical cure strategies given the availability of novel options, such as high-dose primaquine and tafenoquine. The Options Assessment Toolkit (OAT) was developed to assist NMPs to make decisions on the optimal combination of G6PD testing and radical cure drug regimen. This study reports on the piloting of OAT with NMP representatives during the APMEN Vivax Working Group Annual Meeting in December 2022. A total of 23 NMP representatives from 13 Asia-Pacific countries participated in facilitated discussions. Thematic analysis of qualitative data revealed that NMPs found the OAT useful and timely for structuring malaria policy discussions. However, concerns were raised regarding mismatches between OAT-generated scenarios and country-specific contexts, the inclusion of political and economic factors, and the feasibility of implementing expert-suggested options. Many NMPs expressed enthusiasm for single-dose tafenoquine, but preferred to await WHO recommendations before considering policy changes. Overall, the OAT was well received as a tool for initiating policy discussions on P. vivax radical cure. The OAT represents an important step toward accelerating evidence-based policy change in malaria-endemic countries, with further refinements enhancing its utility.