Description
The final challenge to malaria elimination in many areas where transmission has been successfully reduced is Plasmodium vivax. This parasite species forms relapsing life stages in the human liver which reactivate in the weeks to months following infection. These relapses sustain community transmission and impose a cumulative burden of harm on infected patients. The only drugs which can treat these latent infections are primaquine and tafenoquine. Screening for G6PD deficiency is required prior to taking therapeutically effective regimens of these drugs as they can cause clinically significant haemolysis in G6PD deficient patients. G6PD testing is not currently widely available, leading to inadequate levels of P. vivax treatment and delayed progress towards elimination relative to P. falciparum. G6PD diagnosis to ensure equitable access to treatment needs to be quantitative, thus requires a reader. Deciding how to implement this new test type in an accessible, equitable and cost-effective way across countries with falling malaria burdens is key to ensuring country uptake of G6PD testing and P. vivax radical cure. Here we use the analytical approach of Diagnostic Network Optimisation (DNO) to model testing networks in two contrasting epidemiological settings: Bangladesh and Indonesia. Operationalizable results from these analyses, together with estimates of population accessibility and costs of different scenarios are presented. DNO is a proven approach for Ministry of Health programmes to plan and optimise their diagnostic capacities.
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