Piloting the options assessment toolkit with national malaria programme leaders from the Asia–Pacific countries: a meeting report

(2025) 24:187 Shrestha et al. Malaria Journal https://doi.org/10.1186/s12936-025-05432-4 Malaria Journal Open Access MEETING REPORT Piloting the options assessment toolkit with national malaria programme leaders from the Asia–Pacific countries: a meeting report Manash Shrestha1,2*, Sanjaya Acharya3, Josselyn Neukom4, Karma Lhazeen1, Ngo Duc Thang5, Muhammad Naeem Habib6, Lyndes Wini7, Tobgyel Tobgyel8, Kesang Wangchuk8, Huy Rekol9, Lek Dysoley9, Siv Sovannaroth9, Minerva Simatuopang10, Helen Dewi Prameswari10, Asik Surya10, Zau Ring11, Mohammad Qasim Khan12, Boualam Khamlome13, Mohd Hafizi Abdul Hamid14, Ram Kumar Mahato15, Top Thapa15, Sheen Angelou Juangco16, Hee Il Lee17, Hyun Il Shin17, Kumudu Gunasekera18, Champa Aluthwera18, Prayuth Sudathip19, Rungrawee Timpontree19, Hoang Dinh Canh5, Sonia Cheung20, Muhammad Zeeshan Haroon21, Shreehari Acharya22, Robert J. Commons3, Bipin Adhikari23, Varunika Ruwanpura3, Phone Si Hein1, Abhijit Sharma24, Poe Poe Aung25, Neena Valecha1,2, Kamala Thriemer3† and Caroline A. Lynch1,2,3† Abstract Plasmodium vivax malaria remains a major challenge in the Asia–Pacific region, where National Malaria Programmes (NMPs) will need to determine optimal radical cure strategies given the availability of novel options, such as high-dose primaquine and tafenoquine. The Options Assessment Toolkit (OAT) was developed to assist NMPs to make decisions on the optimal combination of G6PD testing and radical cure drug regimen. This study reports on the piloting of OAT with NMP representatives during the APMEN Vivax Working Group Annual Meeting in December 2022. A total of 23 NMP representatives from 13 Asia–Pacific countries participated in facilitated discussions. Thematic analysis of qualitative data revealed that NMPs found the OAT useful and timely for structuring malaria policy discussions. However, concerns were raised regarding mismatches between OAT-generated scenarios and country-specific contexts, the inclusion of political and economic factors, and the feasibility of implementing expert-suggested options. Many NMPs expressed enthusiasm for single-dose tafenoquine, but preferred to await WHO recommendations before considering policy changes. Overall, the OAT was well received as a tool for initiating policy discussions on P. vivax radical cure. The OAT represents an important step toward accelerating evidence-based policy change in malaria-endemic countries, with further refinements enhancing its utility. † Kamala Thriemer and Caroline A. Lynch have contributed equally as joint last authors. *Correspondence: Manash Shrestha Full list of author information is available at the end of the article © The Author(s) 2025. 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To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. Shrestha et al. Malaria Journal (2025) 24:187 Page 2 of 8 Keywords Plasmodium vivax malaria, Radical cure, G6PD testing, Policy decision-making, National malaria programmes, Options Assessment Toolkit Background Over the last two decades, the global incidence of malaria has decreased substantially, but this decline has been far greater for Plasmodium falciparum than for Plasmodium vivax [1, 2], and progress has now stalled [3]. The most recent estimates showed that the global burden of P. vivax malaria is between 13.7 and 15 million cases per year [1]. The emergence of P. vivax malaria as a significant health concern reflects the historical neglect in both malaria research and control efforts. This neglect is partially due to P. vivax malaria being considered less severe than P. falciparum malaria [2, 4]. Furthermore, P. vivax is more difficult to control than P. falciparum, mainly due to its ability to form dormant liver stages (hypnozoites) that can reactivate weeks or months after the initial infection, causing acute disease (relapse) [5]. Recent studies suggest that around 85% of acute P. vivax malaria episodes are caused by relapses [6, 7], indicating that out of 3000 reported cases each year, up to 2550 may be relapses rather than new infections. Effective radical cure, the treatment of both the symptomatic blood stage and the dormant liver stage of the P. vivax parasite, is therefore critical for eliminating malaria [8, 9]. Until recently, the World Health Organization (WHO) recommended radical cure with low-dose primaquine given for 14 days (total dose 3.5 mg/kg at 0.25 mg/kg per day) and this is still the current treatment regimen of choice in many endemic countries [10]. This relatively long treatment regimen is challenging and often results in poor patient adherence [11, 12]. To address reduced adherence to the prolonged 14-day treatment, the WHO recommended a shorter low-dose treatment of 7 days (total dose 3.5 mg/kg at 0.5 mg/kg/day) in November 2022 [13]. To further improve anti-relapse efficacy, as of November 2024, the WHO now recommends a highdose primaquine course given over 7 days (total dose 7 mg/kg at 1 mg/kg per day) [14]. In addition, a singledose treatment with tafenoquine (300 mg) is now recommended for the Latin America region [14]. These latest recommendations came alongside prequalification of a semi-quantitative Glucose-6-Dehydrogenase (G6PD) point-of-care (PoC) test that can identify patients with G6PD deficiency at risk of drug-induced hemolysis [15], and is required to guide both high-dose primaquine and tafenoquine treatment [14]. National malaria programmes (NMPs) in the Asia– Pacific region are faced with determining which treatment regimens for P. vivax malaria are best for their given contexts, with the availability of new tools such as G6PD testing and different radical cure regimens [16–21]. This can pose a challenge to decisionmaking processes, potentially leading to delays in uptake of those novel tools [22]. Most countries in the region aim to eliminate malaria by 2030 [23]. Acceleration of the uptake of new tools into health systems is, therefore, a key consideration for NMPs and they prioritized receiving technical support to determine the optimal combination of P. viv (...truncated)