Brito-Sousa Jose Diego, Murta Felipe, Vitor-Silva Sheila, Sampaio Vanderson, Mendes Maxwell, Souza Brenda, Batista Talita, Santos Alicia, Marques Leonardo, Barbosa Laila, Balieiro Patricia, Silva-Neto Alexandre, Rabello Renata, Brito Marcelo, Silva Emanuelle, Rodovalho Sheila, Arcanjo Ana Ruth, Melo Gisely, Recht Judith, Domingo Gonzalo J, Valle Suiane, Souza Rodrigo, Nakagawa Theresa, Monteiro Wuelton, Lacerda Marcus
Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus 69040-000, Brazil.
Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus 69065-001, Brazil.
Pathogens. 2022 Nov 11;11(11):1328. doi: 10.3390/pathogens11111328.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency testing is not routinely performed before primaquine treatment in most endemic areas, despite the risk of primaquine-associated hemolysis. This is due to the operational challenges associated with pragmatic G6PD testing and as such needs to be addressed.
This mixed-methods operational study was aimed at implementing the quantitative point-of-care Standard G6PD (SD Biosensor, Korea) screening test in malaria treatment units (MTUs) in the municipalities of Rio Preto da Eva and Mâncio Lima, in the Brazilian Amazon, between mid-January 2020 and December 2020. In total, 1286 cases were treated based on the Standard G6PD test: 1230 had activity equal to or greater than 4.0 U/g Hb, and 56 less than 4.0 U/g Hb. No G6PD deficient (G6PDd) genotypes were found in 96 samples from the 1230, and only 21 of the 56 G6PDd cases had confirmed G6PDd genotypes. Evaluations were conducted on the proficiency of health care professionals (HCPs) training to perform the test, the reliability of testing performed in the field, and the perceptions of HCPs and patients about the implementation. Post-training proficiency was 73.4% after a 4-hour training session. This study revealed that locations with lower malaria caseloads will need regular refresher training. The test was well accepted by both HCPs and patients. Signs and symptoms of hemolysis were not always associated with malaria treatment drugs by HCPs and patients.
Point-of-care quantitative G6PD testing can be performed at MTUs in the Brazilian Amazon to inform treatment decisions with primaquine. Limitations related to technical and cultural aspects need to be addressed further when expanding screening to larger areas.
尽管存在伯氨喹相关溶血风险，但在大多数流行地区，伯氨喹治疗前通常不常规进行葡萄糖-6-磷酸脱氢酶（G6PD）缺乏症检测。这是由于实用的G6PD检测存在操作挑战，因此需要加以解决。
这项混合方法的操作性研究旨在2020年1月中旬至2020年12月期间，在巴西亚马逊地区的里奥普雷图达伊娃市和曼西奥利马市的疟疾治疗单位（MTU）实施定量即时检验标准G6PD（SD生物传感器，韩国）筛查试验。总共根据标准G6PD试验治疗了1286例病例：1230例活性等于或大于4.0 U/g Hb，56例低于4.0 U/g Hb。在1230例的96份样本中未发现G6PD缺乏（G6PDd）基因型，56例G6PDd病例中只有21例确诊为G6PDd基因型。对医疗保健专业人员（HCP）进行检测培训的熟练程度、现场检测的可靠性以及HCP和患者对实施情况的看法进行了评估。经过4小时培训后，培训后的熟练程度为73.4%。本研究表明，疟疾病例数较少的地区需要定期进行复习培训。该检测受到HCP和患者的广泛接受。HCP和患者并不总是将溶血的体征和症状与疟疾治疗药物联系起来。
巴西亚马逊地区的MTU可以进行即时检验定量G6PD检测，以为伯氨喹治疗决策提供依据。在将筛查扩大到更大区域时，与技术和文化方面相关的局限性需要进一步解决。
