Jose Diego Brito-Sousa1,2, Felipe Murta1,2, Sheila Vitor-Silva1,3, Vanderson S Sampaio1,2,4, Maxwell O Mendes1, Marcelo A M Brito1, Talita S B Batista1, Alicia P C Santos1,2, Leonardo L G Marques1, Laila R A Barbosa1,2, Marly M Melo1,2, Djane C Baia-da-Silva1, Alexandre V Silva-Neto1, Thalie C Santos1, Brenda K A Souza1, Erick F G Figueiredo1,2, Emanuelle L Silva1, Sheila Rodovalho2,5, Theresa H Nakagawa1, Ana Ruth Arcanjo6, André M Siqueira7, Gisely C Melo1,2, Judith Recht8, Gonzalo J Domingo9, Quique Bassat10,11,12,13,14, Germana Bancone15,16, Wuelton M Monteiro1,2, Marcus V G Lacerda1,17. 1. Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil. 2. Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil. 3. Escola de Enfermagem de Manaus, Universidade Federal do Amazonas, Manaus, Brazil. 4. Fundação de Vigilância em Saúde do Amazonas-FVS-AM, Manaus, Brazil. 5. Pan American Health Organization-PAHO, World Health Organization, Brasilia, Brazil. 6. Laboratório Central de Saúde Pública do Amazonas-LACEN/AM, Manaus, Brazil. 7. Fundação Oswaldo Cruz, Instituto Nacional de Infectologia-INI, Rio de Janeiro, Brazil. 8. Independent consultant, North Bethesda, Maryland, United States of America. 9. Diagnostics Program, PATH, Seattle, Washington, United States of America. 10. Institut de Salut Global de Barcelona (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain. 11. Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique. 12. Institució Catalana de Recerca i Estudis Avançats (ICREA), Pg. Lluís Companys, Barcelona, Spain. 13. Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain. 14. Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. 15. Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand. 16. Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom. 17. Fundação Oswaldo Cruz, Instituto Leônidas e Maria Deane-ILMD, Manaus, Amazonas, Brazil.
Abstract
BACKGROUND: Glucose-6-phosphate dehydrogenase (G6PD) deficiency greatly hinders Plasmodium vivax malaria radical cure and further elimination due to 8-aminoquinolines-associated hemolysis. Although the deleterious health effects of primaquine in G6PD deficient individuals have been known for over 50 years, G6PD testing is not routinely performed before primaquine treatment in most P. vivax endemic areas. METHOD/PRINCIPAL FINDINGS: The qualitative CareStart G6PD screening test was implemented in 12 malaria treatment units (MTUs) in the municipality of Rio Preto da Eva, Western Brazilian Amazon, a malaria endemic area, between February 2019 and early January 2020. Training materials were developed and validated; evaluations were conducted on the effectiveness of training health care professionals (HCPs) to perform the test, the interpretation and reliability of routine testing performed by HCPs, and perceptions of HCPs and patients. Most HCPs were unaware of G6PD deficiency and primaquine-related adverse effects. Most of 110 HCPs trained (86/110, 78%) were able to correctly perform the G6PD test after a single 4-hour training session. The test performed by HCPs during implementation showed 100.0% (4/4) sensitivity and 68.1% (62/91) specificity in identifying G6PD deficient patients as compared to a point-of-care quantitative test (Standard G6PD). CONCLUSIONS/SIGNIFICANCE: G6PD screening using the qualitative CareStart G6PD test performed by HCPs in MTUs of an endemic area showed high sensitivity and concerning low specificity. The amount of false G6PD deficiency detected led to substantial loss of opportunities for radical cure.
BACKGROUND:Glucose-6-phosphate dehydrogenase (G6PD) deficiency greatly hinders Plasmodium vivaxmalaria radical cure and further elimination due to 8-aminoquinolines-associated hemolysis. Although the deleterious health effects of primaquine in G6PD deficient individuals have been known for over 50 years, G6PD testing is not routinely performed before primaquine treatment in most P. vivax endemic areas. METHOD/PRINCIPAL FINDINGS: The qualitative CareStart G6PD screening test was implemented in 12 malaria treatment units (MTUs) in the municipality of Rio Preto da Eva, Western Brazilian Amazon, a malaria endemic area, between February 2019 and early January 2020. Training materials were developed and validated; evaluations were conducted on the effectiveness of training health care professionals (HCPs) to perform the test, the interpretation and reliability of routine testing performed by HCPs, and perceptions of HCPs and patients. Most HCPs were unaware of G6PD deficiency and primaquine-related adverse effects. Most of 110 HCPs trained (86/110, 78%) were able to correctly perform the G6PD test after a single 4-hour training session. The test performed by HCPs during implementation showed 100.0% (4/4) sensitivity and 68.1% (62/91) specificity in identifying G6PD deficientpatients as compared to a point-of-care quantitative test (Standard G6PD). CONCLUSIONS/SIGNIFICANCE:G6PD screening using the qualitative CareStart G6PD test performed by HCPs in MTUs of an endemic area showed high sensitivity and concerning low specificity. The amount of false G6PD deficiency detected led to substantial loss of opportunities for radical cure.
Authors: Felipe L G Murta; Leonardo L G Marques; Alicia P C Santos; Talita S B Batista; Maxwell O Mendes; Elair D Silva; Alexandre V S Neto; Marcio Fabiano; Sheila R Rodovalho; Wuelton M Monteiro; Marcus V G Lacerda Journal: Malar J Date: 2021-06-26 Impact factor: 2.979
Authors: Jose Diego Brito-Sousa; Henry M Peixoto; Angela Devine; Alexandre V Silva-Neto; Patricia C S Balieiro; Vanderson S Sampaio; Sheila Vitor-Silva; Maxwell O Mendes; Brenda K A Souza; Marcus V G Lacerda; Wuelton M Monteiro Journal: PLoS Negl Trop Dis Date: 2022-03-24