Perceived challenges in implementing point-of-care testing for glucose-6-phosphate- dehydrogenase for malaria patients before primaquine treatment in the Philippines

Background: The National Malaria Control and Elimination Program (NCEP) aimed to eliminate the disease by 2030. Among the challenges to achieving this goal was the radical treatment of malaria. The Philippines was among the very few countries that administer primaquine for Plasmodium vivax and Plasmodium ovale without prior testing for glucose-6-phosphate-dehydrogenase(G6PD). G6PD testing before administering primaquine (15 mg/kg/day) was recommended in the Philippines’ malaria treatment guidelines but the point-of-care qualitative test kits were not available for use in barangay malaria microscopy centers (BMMC) where malaria diagnosis and treatment occurred. Methods This study explored the challenges in implementing G6PD testing for the radical treatment of malaria. The main methods employed were stakeholder analysis and service availability and readiness assessment including the feedback of the health providers on the type of G6PD test kit that was proposed to be deployed and used. Results The challenges identified by the stakeholders were: (a) they perceived a low to no documented case of primaquine-induced hemolysis; (b) the impression of low-transmission of vivax infection; (c) the additional budget for the roll-out of g6pd testing for malaria patients; (d) no established treatment guidelines for malaria patients with G6PD deficiency; (e) additional workload for the health care providers; (f) lack of training on G6PD deficient patient management and on how to perform and interpret the result of the G6PD test. SARA survey showed that all facilities were equipped and have the capacity to conduct the test, however, training for the health providers should be provided. Conclusions The roll-out of a point-of-care test for G6PD deficiency should be prioritized to achieve an effective radical cure for malaria. A cost-benefit analysis should be explored to support the implementation of G6PD testing prior to primaquine treatment.