Prospective observational study to assess the feasibility and safety of appropriate <i>Plasmodium vivax</i> radical cure with tafenoquine or primaquine after quantitative G6PD testing during pilot implementation in Thailand
Bibliographic record
Abstract
Introduction Plasmodium vivax recurrence prevention using tafenoquine or primaquine is critical for achieving Thailand’s malaria elimination targets. Both drugs may cause haemolysis in glucose-6-phosphate dehydrogenase (G6PD) deficient individuals. This study evaluated the operational feasibility and safety of administering tafenoquine or primaquine after quantitative G6PD point-of-care testing in Thailand. Methods This prospective, observational, multicentre, longitudinal study was conducted between 23 May 2022 and 14 September 2023 during pilot implementation at seven sites in Yala and Mae Hong Son provinces. Eligible patients were ≥16 years old with uncomplicated P. vivax malaria. G6PD enzyme activity was quantified using a point-of-care device. All patients received 3-day chloroquine plus (based on G6PD enzyme activity): single-dose tafenoquine 300 mg (≥6.1 U/g Hb), or primaquine 15 mg/day for 14 days (≥4.1 U/g Hb), or primaquine 45 mg/week for 8 weeks (≤4.0 U/g Hb), with follow-up on days 5 and 14. Hospital admissions were reviewed to confirm acute haemolytic anaemia cases. The primary endpoint was the percentage of P. vivax patients ≥16 years old treated or not treated with tafenoquine in accordance with G6PD enzyme activity. Results Of 316 P . vivax patients screened, 187 were enrolled. All patients completed quantitative G6PD testing. According to G6PD status, appropriate use or non-use was 100% (95% CI 97.2, 100 (132/132)) with tafenoquine, 100% (95% CI 96.5, 100 (104/104)) with daily primaquine and 99.5% (97.1, 100 (186/187)) with weekly primaquine. At day 5, adverse events possibly related to haemolysis occurred in 46.3% (37/80) of patients with tafenoquine, 56.8% (46/81) with daily primaquine and 77.8% (14/18) with weekly primaquine, with no confirmed drug-induced acute haemolytic anaemia cases. Conclusion Point-of-care quantitative G6PD testing prior to appropriate tafenoquine or primaquine administration was operationally feasible within the Thailand health system, with no concerning adverse events, supporting implementation of this treatment algorithm in areas of active P. vivax transmission.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".