PDF(Pubmed)
Abstract：
Effective radical cure of Plasmodium vivax malaria is essential for malaria elimination in Brazil. P. vivax radical cure requires administration of a schizonticide, such as chloroquine, plus an 8-aminoquinoline. However, 8-aminoquinolines cause hemolysis in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, requiring prior screening to exclude those at risk. Brazil is pioneering the implementation of tafenoquine, a single-dose 8-aminoquinoline indicated for P. vivax patients with >70% of normal G6PD activity. Tafenoquine implementation in Manaus and Porto Velho, two municipalities located in the western Brazilian Amazon, included comprehensive training of healthcare professionals (HCPs) on point-of-care quantitative G6PD testing and a new treatment algorithm for P. vivax radical cure incorporating tafenoquine. Training was initially provided to higher-level facilities (phase one) and later adapted for primary care units (phase two). This study analyzed HCP experiences during training and implementation and identified barriers and facilitators. In-depth interviews and focus discussion groups were conducted 30 days after each training for a purposive random sample of 115 HCPs. Thematic analysis was employed using MAXQDA software, analyzing data through inductive and deductive coding. Analysis showed that following the initial training for higher-level facilities, some HCPs did not feel confident performing quantitative G6PD testing and prescribing the tafenoquine regimen. Modifications to the training in phase two resulted in an improvement in understanding the implementation process of the G6PD test and tafenoquine, as well as in the knowledge acquired by HCPs. Additionally, knowledge gaps were addressed through in situ training, peer communication via a messaging app, and educational materials. Training supported effective deployment of the new tools in Manaus and Porto Velho and increased awareness of the need for pharmacovigilance. A training approach for nationwide implementation of these tools was devised. Implementing quantitative G6PD testing and tafenoquine represents a significant shift in P. vivax malaria case management. Consistent engagement with HCPs is needed to overcome challenges in fully integrating these tools within the Brazilian health system.
摘要：
间日疟原虫疟疾的有效根治对于在巴西消除疟疾至关重要。间日疟原虫根治需要服用杀裂殖剂，如氯喹，再加上8-氨基喹啉.然而,8-氨基喹啉类引起葡萄糖-6-磷酸脱氢酶（G6PD）缺乏症患者溶血，需要事先筛查以排除有风险的人。巴西正在率先实施他非诺喹，单剂量8-氨基喹啉适用于G6PD活性>70%正常的间日疟原虫患者。在马瑙斯和韦略港实施他非诺喹，位于巴西亚马逊西部的两个城市，包括对医疗保健专业人员（HCP）进行即时定量G6PD测试的全面培训，以及结合他非诺喹的间日疟原虫根治新治疗算法。培训最初提供给更高级别的设施(第一阶段)，后来适应初级保健单位(第二阶段)。这项研究分析了培训和实施过程中的HCP经验，并确定了障碍和促进者。每次培训后30天，对115个HCP进行了有目的的随机抽样，进行了深入访谈和焦点讨论小组。使用MAXQDA软件进行主题分析，通过归纳和演绎编码分析数据。分析表明，在对更高级别的设施进行初步培训之后，一些HCP对进行定量G6PD检测和开具他非诺喹方案没有信心.对第二阶段培训的修改提高了对G6PD测试和他非诺喹实施过程的理解，以及HCP获得的知识。此外,通过现场培训解决了知识差距，通过消息传递应用程序进行对等通信，和教育材料。培训支持在马瑙斯和韦略港有效部署新工具，并提高了对药物警戒必要性的认识。设计了在全国范围内实施这些工具的培训方法。实施定量G6PD检测和他非诺喹代表了间日疟原虫疟疾病例管理的重大转变。需要与HCPs保持一致的合作，以克服在将这些工具充分整合到巴西卫生系统中的挑战。
