Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia.
Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, CA, USA.
Malar J. 2017 Aug 10;16(1):329. doi: 10.1186/s12936-017-1981-y.
Primaquine is essential for the radical cure of vivax malaria, however its broad application is hindered by the risk of drug-induced haemolysis in individuals with glucose-6-phosphate-dehydrogenase (G6PD) deficiency. Rapid diagnostic tests capable of diagnosing G6PD deficiency are now available, but these are not used widely.
A series of qualitative interviews were conducted with policy makers and healthcare providers in four vivax-endemic countries. Routine G6PD testing is not part of current policy in Bangladesh, Cambodia or China, but it is in Malaysia. The interviews were analysed with regard to respondents perceptions of vivax malaria, -primaquine based treatment for malaria and the complexities of G6PD deficiency.
Three barriers to the roll-out of routine G6PD testing were identified in all sites: (a) a perceived low risk of drug-induced haemolysis; (b) the perception that vivax malaria was benign and accordingly treatment with primaquine was not regarded as a priority; and, (c) the additional costs of introducing routine testing. In Malaysia, respondents considered the current test and treat algorithm suitable and the need for an alternative approach was only considered relevant in highly mobile and hard to reach populations.
Greater efforts are needed to increase awareness of the benefits of the radical cure of Plasmodium vivax and this should be supported by economic analyses exploring the cost effectiveness of routine G6PD testing.
伯氨喹对根治间日疟至关重要，但由于葡萄糖-6-磷酸脱氢酶（G6PD）缺乏症患者存在药物诱导溶血性贫血的风险，其广泛应用受到阻碍。现在已有能够诊断 G6PD 缺乏症的快速诊断测试，但并未广泛使用。
在四个间日疟流行国家，对政策制定者和医疗保健提供者进行了一系列定性访谈。孟加拉国、柬埔寨和中国目前的政策均不包括常规 G6PD 检测，但马来西亚有此规定。分析受访者对间日疟、基于伯氨喹的疟疾治疗以及 G6PD 缺乏症复杂性的看法。
在所有地点均发现了常规 G6PD 检测推广的三个障碍：（a）认为药物诱导溶血性贫血风险低；（b）认为间日疟是良性的，因此治疗伯氨喹不是优先事项；（c）引入常规检测的额外费用。在马来西亚，受访者认为当前的检测和治疗算法是合适的，只有在流动性强且难以到达的人群中，才需要考虑替代方法。
需要加大力度提高根治间日疟的认识，还应通过经济分析来支持这一点，以探索常规 G6PD 检测的成本效益。
