title: Challenges for achieving safe and effective radical cure of Plasmodium vivax: a round table discussion of the APMEN Vivax Working Group.
abstract: The delivery of safe and effective radical cure for Plasmodium vivax is one of the greatest challenges for achieving malaria elimination from the Asia-Pacific by 2030. During the annual meeting of the Asia Pacific Malaria Elimination Network Vivax Working Group in October 2016, a round table discussion was held to discuss the programmatic issues hindering the widespread use of primaquine (PQ) radical cure. Participants included 73 representatives from 16 partner countries and 33 institutional partners and other research institutes. In this meeting report, the key discussion points are presented and grouped into five themes: (i) current barriers for glucose-6-phosphate deficiency (G6PD) testing prior to PQ radical cure, (ii) necessary properties of G6PD tests for wide scale deployment, (iii) the promotion of G6PD testing, (iv) improving adherence to PQ regimens and (v) the challenges for future tafenoquine (TQ) roll out. Robust point of care (PoC) G6PD tests are needed, which are suitable and cost-effective for clinical settings with limited infrastructure. An affordable and competitive test price is needed, accompanied by sustainable funding for the product with appropriate training of healthcare staff, and robust quality control and assurance processes. In the absence of quantitative PoC G6PD tests, G6PD status can be gauged with qualitative diagnostics, however none of the available tests is currently sensitive enough to guide TQ treatment. TQ introduction will require overcoming additional challenges including the management of severely and intermediately G6PD deficient individuals. Robust strategies are needed to ensure that effective treatment practices can be deployed widely, and these should ensure that the caveats are outweighed by  the benefits of radical cure for both the patients and the community. Widespread access to quality controlled G6PD testing will be critical.
authors.affiliation: Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia. kamala.ley-thriemer@menzies.edu.au.
authors.forename: Kamala
authors.identifier: 0000-0003-2000-2874
authors.initials: K
authors.lastname: Thriemer
authors.affiliation: Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Ley
authors.affiliation: National Vector Borne Disease Control Programme, Honiara, Solomon Islands.
authors.forename: Albino
authors.initials: A
authors.lastname: Bobogare
authors.affiliation: National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia.|School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia.
authors.forename: Lek
authors.initials: L
authors.lastname: Dysoley
authors.affiliation: International Centre for Diarrheal Diseases and Research, Dhaka, Bangladesh.
authors.forename: Mohammad Shafiul
authors.initials: MS
authors.lastname: Alam
authors.affiliation: Department of Pediatrics, Medical Faculty, University of Sumatera Utara, Medan, Indonesia.
authors.forename: Ayodhia P
authors.initials: AP
authors.lastname: Pasaribu
authors.affiliation: Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangok, Thailand.
authors.forename: Jetsumon
authors.initials: J
authors.lastname: Sattabongkot
authors.affiliation: Medicines for Malaria Venture (MMV), Geneva, Switzerland.
authors.forename: Elodie
authors.initials: E
authors.lastname: Jambert
authors.affiliation: Diagnostics Program, PATH, Seattle, USA.
authors.forename: Gonzalo J
authors.initials: GJ
authors.lastname: Domingo
authors.affiliation: Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Commons
authors.affiliation: Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Auburn
authors.affiliation: Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia.
authors.forename: Jutta
authors.initials: J
authors.lastname: Marfurt
authors.affiliation: Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangok, Thailand.|Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
authors.forename: Angela
authors.initials: A
authors.lastname: Devine
authors.affiliation: Ministry of Health and Family Welfare, Malaria and Parasitic Disease Control, Director General of Health Services, Mohakhali, Dhaka, Bangladesh.
authors.forename: Mohammad M
authors.initials: MM
authors.lastname: Aktaruzzaman
authors.affiliation: Ministry of Health and Family Welfare, Malaria and Parasitic Disease Control, Director General of Health Services, Mohakhali, Dhaka, Bangladesh.
authors.forename: Nayeem
authors.initials: N
authors.lastname: Sohel
authors.affiliation: Vector-borne Disease Control Programme (VDCP), Department of Public Health, Ministry of Health in Bhutan, Thimphu, Bhutan.
authors.forename: Rinzin
authors.initials: R
authors.lastname: Namgay
authors.affiliation: Vector-borne Disease Control Programme (VDCP), Department of Public Health, Ministry of Health in Bhutan, Thimphu, Bhutan.
authors.forename: Tobgyel
authors.initials: T
authors.lastname: Drukpa
authors.affiliation: National Vector Borne Disease Control Programme Directorate General of Health Services Ministry of Health & Family Welfare, New Delhi, India.
authors.forename: Surender Nath
authors.initials: SN
authors.lastname: Sharma
authors.affiliation: National Malaria Control Program, Jakarta, Indonesia.
authors.forename: Elvieda
authors.initials: E
authors.lastname: Sarawati
authors.affiliation: National Malaria Control Program, Jakarta, Indonesia.
authors.forename: Iriani
authors.initials: I
authors.lastname: Samad
authors.affiliation: National Malaria Control Program, Jakarta, Indonesia.
authors.forename: Minerva
authors.initials: M
authors.lastname: Theodora
authors.affiliation: National Center for Entomology Parasitology and Malaria Control, Vientiane, Laos.
authors.forename: Simone
authors.initials: S
authors.lastname: Nambanya
authors.affiliation: Vector-borne Diseases Control Programme, Ministry of Health Malaysia, Kuala Lumpur, Malaysia.
authors.forename: Sonesay
authors.initials: S
authors.lastname: Ounekham
authors.affiliation: Vector-borne Diseases Control Programme, Ministry of Health Malaysia, Kuala Lumpur, Malaysia.
authors.forename: Rose Nanti Binti
authors.initials: RN
authors.lastname: Mudin
authors.affiliation: Malaria Control Programme, Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal.
authors.forename: Garib
authors.initials: G
authors.lastname: Da Thakur
authors.affiliation: National Malaria Control Programme, Goroka, Papua New Guinea.
authors.forename: Leo Sora
authors.initials: LS
authors.lastname: Makita
authors.affiliation: Malaria Control Programme, Department of Health, Manila, Philippines.
authors.forename: Raffy
authors.initials: R
authors.lastname: Deray
authors.affiliation: Division of Malaria & Parasitic Diseases, Korea Centers for Disease Control and Prevention, Seoul, South Korea.
authors.forename: Sang-Eun
authors.initials: SE
authors.lastname: Lee
authors.affiliation: National Vector Borne Disease Control Programme, Honiara, Solomon Islands.
authors.forename: Leonard
authors.initials: L
authors.lastname: Boaz
authors.affiliation: Antimalaria Campaign, Ministry of Health, Colombo, Sri Lanka.
authors.forename: Manjula N
authors.initials: MN
authors.lastname: Danansuriya
authors.affiliation: Antimalaria Campaign, Ministry of Health, Colombo, Sri Lanka.
authors.forename: Santha D
authors.initials: SD
authors.lastname: Mudiyanselage
authors.affiliation: Bureau of Vector-Borne Disease, Department of Disease Control, Ministry of Public Health, Bangkok, Thailand.
authors.forename: Nipon
authors.initials: N
authors.lastname: Chinanonwait
authors.affiliation: Bureau of Vector-Borne Disease, Department of Disease Control, Ministry of Public Health, Bangkok, Thailand.
authors.forename: Suravadee
authors.initials: S
authors.lastname: Kitchakarn
authors.affiliation: National Malaria Control Programme, Port Vila, Vanuatu.
authors.forename: Johnny
authors.initials: J
authors.lastname: Nausien
authors.affiliation: National Malaria Control Programme, Port Vila, Vanuatu.
authors.forename: Esau
authors.initials: E
authors.lastname: Naket
authors.affiliation: National Institute of Malaria, Parasitology, and Entomology (NIMPE), Tam Kỳ, Vietnam.
authors.forename: Thang Ngo
authors.initials: TN
authors.lastname: Duc
authors.affiliation: National Institute of Malaria, Parasitology, and Entomology (NIMPE), Tam Kỳ, Vietnam.
authors.forename: Ha
authors.initials: H
authors.lastname: Do Manh
authors.affiliation: Access Bio Inc, Monmouth, USA.
authors.forename: Young S
authors.initials: YS
authors.lastname: Hong
authors.affiliation: Australian Army Malaria Institute, Enoggera, QLD, Australia.
authors.forename: Qin
authors.initials: Q
authors.lastname: Cheng
authors.affiliation: Centre for Biomedical Research, Burnet Institute, Melbourne, Australia.
authors.forename: Jack S
authors.initials: JS
authors.lastname: Richards
authors.affiliation: Vector Borne Disease Control, Ministry of Health, Jakarta, Indonesia.|Indonesian Parasitic Association, Jakarta, Indonesia.
authors.forename: Rita
authors.initials: R
authors.lastname: Kusriastuti
authors.affiliation: Eijkman Institute of Molecular Biology, Jakarta, Indonesia.
authors.forename: Ari
authors.initials: A
authors.lastname: Satyagraha
authors.affiliation: Eijkman Institute of Molecular Biology, Jakarta, Indonesia.
authors.forename: Rintis
authors.initials: R
authors.lastname: Noviyanti
authors.affiliation: FIND, Geneva, Switzerland.
authors.forename: Xavier C
authors.initials: XC
authors.lastname: Ding
authors.affiliation: International Centre for Diarrheal Diseases and Research, Dhaka, Bangladesh.
authors.forename: Wasif Ali
authors.initials: WA
authors.lastname: Khan
authors.affiliation: International Centre for Diarrheal Diseases and Research, Dhaka, Bangladesh.
authors.forename: Ching
authors.initials: C
authors.lastname: Swe Phru
authors.affiliation: Jiangsu Institute of Parasitic Diseases, Wuxi, China.
authors.forename: Zhu
authors.initials: Z
authors.lastname: Guoding
authors.affiliation: Jiangsu Institute of Parasitic Diseases, Wuxi, China.
authors.forename: Gao
authors.initials: G
authors.lastname: Qi
authors.affiliation: Karolinska Institutet, Stockholm, Sweden.|Osaka City University, Osaka, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Kaneko
authors.affiliation: Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangok, Thailand.|Centre for Genomics and Global Health, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK.|Wellcome Trust Sanger Institute, Hinxton, UK.
authors.forename: Olivo
authors.initials: O
authors.lastname: Miotto
authors.affiliation: Department of Molecular Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Salaya, Thailand.
authors.forename: Wang
authors.initials: W
authors.lastname: Nguitragool
authors.affiliation: Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangok, Thailand.
authors.forename: Wanlapa
authors.initials: W
authors.lastname: Roobsoong
authors.affiliation: Malaria Atlas Project, Nuffield Department of Medicine, Oxford Big Data Institute, University of Oxford, Oxford, UK.
authors.forename: Katherine
authors.initials: K
authors.lastname: Battle
authors.affiliation: Malaria Atlas Project, Nuffield Department of Medicine, Oxford Big Data Institute, University of Oxford, Oxford, UK.
authors.forename: Rosalind E
authors.initials: RE
authors.lastname: Howes
authors.affiliation: Malaria Consortium, London, UK.
authors.forename: Arantxa
authors.initials: A
authors.lastname: Roca-Feltrer
authors.affiliation: Medicines for Malaria Venture (MMV), Geneva, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Duparc
authors.affiliation: Model Rural Health Research Unit (MRHRU), Tripura State, ICMR, Agartala, India.
authors.forename: Ipsita Pal
authors.initials: IP
authors.lastname: Bhowmick
authors.affiliation: Yayasan Pengembangan Kesehatan dan Masyarakat Papua Timika, Timika, Indonesia.
authors.forename: Enny
authors.initials: E
authors.lastname: Kenangalem
authors.affiliation: The Research Institute for Tropical Medicine, Manila, Philippines.
authors.forename: Jo-Anne
authors.initials: JA
authors.lastname: Bibit
authors.affiliation: The Walter + Eliza Hall Institute of Medical Research, Melbourne, Australia.|Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.
authors.forename: Alyssa
authors.initials: A
authors.lastname: Barry
authors.affiliation: President's Malaria Initiative, United States Agency for International Development, Bangkok, Thailand.
authors.forename: David
authors.initials: D
authors.lastname: Sintasath
authors.affiliation: World Health Organization Western Pacific Region, Manila, Philippines.
authors.forename: Rabindra
authors.initials: R
authors.lastname: Abeyasinghe
authors.affiliation: WWARN, Oxford, UK.|University of Washington, Seattle, WA, USA.
authors.forename: Carol H
authors.initials: CH
authors.lastname: Sibley
authors.affiliation: QIMR Berghofer Medical Research Institute, Brisbane, Australia.
authors.forename: James
authors.initials: J
authors.lastname: McCarthy
authors.affiliation: Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangok, Thailand.
authors.forename: Lorenz
authors.initials: L
authors.lastname: von Seidlein
authors.affiliation: Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.|Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Baird
authors.affiliation: Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia.|Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
authors.forename: Ric N
authors.initials: RN
authors.lastname: Price
mesh_terms: D000962:Antimalarials / Q000008:administration & dosage* / Q000009:adverse effects*; D001208:Asia; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control; D005955:Glucosephosphate Dehydrogenase Deficiency / Q000175:diagnosis; D006801:Humans; D016780:Malaria, Vivax / Q000188:drug therapy*; D010139:Pacific Islands
chemical_list: D000962:Antimalarials
keywords: APMEN; P. vivax; Primaquine; Radical cure; Tafenoquine; Vivax malaria