title: The challenges of introducing routine G6PD testing into radical cure: a workshop report.
abstract: The only currently available drug that effectively removes malaria hypnozoites from the human host is primaquine. The use of 8-aminoquinolines is hampered by haemolytic side effects in glucose-6-phosphate dehydrogenase (G6PD) deficient individuals. Recently a number of qualitative and a quantitative rapid diagnostic test (RDT) format have been developed that provide an alternative to the current standard G6PD activity assays. The WHO has recently recommended routine testing of G6PD status prior to primaquine radical cure whenever possible. A workshop was held in the Philippines in early 2015 to discuss key challenges and knowledge gaps that hinder the introduction of routine G6PD testing. Two point-of-care (PoC) test formats for the measurement of G6PD activity are currently available: qualitative tests comparable to malaria RDT as well as biosensors that provide a quantitative reading. Qualitative G6PD PoC tests provide a binomial test result, are easy to use and some products are comparable in price to the widely used fluorescent spot test. Qualitative test results can accurately classify hemizygous males, heterozygous females, but may misclassify females with intermediate G6PD activity. Biosensors provide a more complex quantitative readout and are better suited to identify heterozygous females. While associated with higher costs per sample tested biosensors have the potential for broader use in other scenarios where knowledge of G6PD activity is relevant as well. The introduction of routine G6PD testing is associated with additional costs on top of routine treatment that will vary by setting and will need to be assessed prior to test introduction. Reliable G6PD PoC tests have the potential to play an essential role in future malaria elimination programmes, however require an improved understanding on how to best integrate routine G6PD testing into different health settings.
authors.affiliation: Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia. benedikt.ley@menzies.edu.au.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Ley
authors.affiliation: PATH, Diagnostics Program, Seattle, WA, USA. nluter@path.org.
authors.forename: Nick
authors.initials: N
authors.lastname: Luter
authors.affiliation: Research Institute of Tropical Medicine, Manila, Philippines. fe.espino2012@gmail.com.
authors.forename: Fe Esperanza
authors.initials: FE
authors.lastname: Espino
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand. Angela@tropmedres.ac.|Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK. Angela@tropmedres.ac.
authors.forename: Angela
authors.initials: A
authors.lastname: Devine
authors.affiliation: PATH, Diagnostics Program, Seattle, WA, USA. mkalnoky@path.org.
authors.forename: Michael
authors.initials: M
authors.lastname: Kalnoky
authors.affiliation: Research Institute of Tropical Medicine, Manila, Philippines. yoel@tropmedres.ac.|Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK. yoel@tropmedres.ac.
authors.forename: Yoel
authors.initials: Y
authors.lastname: Lubell
authors.affiliation: Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia. kamala.ley-thriemer@menzies.edu.au.
authors.forename: Kamala
authors.initials: K
authors.lastname: Thriemer
authors.affiliation: Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia. jkevinbaird@yahoo.com.|Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK. jkevinbaird@yahoo.com.
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Baird
authors.affiliation: The Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, CA, USA. eugenie.poirot@ucsf.edu.
authors.forename: Eugenie
authors.initials: E
authors.lastname: Poirot
authors.affiliation: Malaria Consortium, Bangkok, Thailand. n.conan@malariaconsortium.org.
authors.forename: Nolwenn
authors.initials: N
authors.lastname: Conan
authors.affiliation: Disease Control Division, Ministry of Health Malaysia, Kuala Lumpur, Malaysia. drchongck@moh.gov.my.
authors.forename: Chong Chee
authors.initials: CC
authors.lastname: Kheong
authors.affiliation: National Center for Parasitology Entomology and Malaria Control, Phnom Penh, Cambodia. soleycnm@gmail.com.|School of Public Health, National Institution of Public Health, Phnom Penh, Cambodia. soleycnm@gmail.com.
authors.forename: Lek
authors.initials: L
authors.lastname: Dysoley
authors.affiliation: International Center for Diarrheal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh. wakhan@icddrb.org.
authors.forename: Wasif Ali
authors.initials: WA
authors.lastname: Khan
authors.affiliation: Newborn Screening Center, Institute of Human Genetics, National Institutes of Health, University of the Philippines, Manila, Philippines. agberboso@post.upm.edu.ph.
authors.forename: April G
authors.initials: AG
authors.lastname: Dion-Berboso
authors.affiliation: Shoklo Malaria Research Unit, Mae Sot, Tak Province, Thailand. germana@tropmedres.ac.
authors.forename: Germana
authors.initials: G
authors.lastname: Bancone
authors.affiliation: The Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, CA, USA. Jimee.Hwang@ucsf.edu.|Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. Jimee.Hwang@ucsf.edu.
authors.forename: Jimee
authors.initials: J
authors.lastname: Hwang
authors.affiliation: PATH, Diagnostics Program, Seattle, WA, USA. rikumar@path.org.
authors.forename: Ritu
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia. ricprice99@gmail.com.|Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK. ricprice99@gmail.com.
authors.forename: Ric N
authors.initials: RN
authors.lastname: Price
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand. lorenz@tropmedres.ac.|Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK. lorenz@tropmedres.ac.
authors.forename: Lorenz
authors.initials: L
authors.lastname: von Seidlein
authors.affiliation: PATH, Diagnostics Program, Seattle, WA, USA. gdomingo@path.org.
authors.forename: Gonzalo J
authors.initials: GJ
authors.lastname: Domingo
mesh_terms: D000962:Antimalarials / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005954:Glucosephosphate Dehydrogenase / Q000235:genetics*; D005955:Glucosephosphate Dehydrogenase Deficiency / Q000175:diagnosis*; D006801:Humans; D016780:Malaria, Vivax / Q000188:drug therapy*; D008297:Male; D010966:Plasmodium vivax; D019095:Point-of-Care Systems; D011319:Primaquine / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000962:Antimalarials; D005954:Glucosephosphate Dehydrogenase; D011319:Primaquine