Implementation Efforts for New Malaria Tools and Approaches in Latin America

Latin America: Implementation efforts for new malaria tools and approaches 

The 2023 PAVE Regional Meeting convened virtually on November 14th, gathering around 120 participants. Among them were representatives from Ministries of Health (MoH), the Pan American Health Organization (PAHO), local research institutions, global and regional organizations, private sector partners, funders and other partners across Latin American advancing efforts toward regional malaria elimination. The event also featured the participation of MoH representatives from Brazil, Colombia, Peru, Guatemala, Honduras and Panama, that are partners of the PAVE initiative. 

This year marked the fourth PAVE Regional Meeting, an event that has been serving as a pivotal platform to enable the exchange of experiences to address the complexities of malaria in the region. This year, participants delved into recent implementation endeavors involving new tools and approaches to Plasmodium vivax (P. vivax) radical cure and discussed challenges and efforts to reach special populations. 

The event was composed of three panels and closing remarks. 

Pilot implementation of G6PD testing throughout Latin America 

The first panel centered on the pilot implementation of G6PD testing in Colombia, Guatemala, Honduras, and Panama. Led by local MoHs and research institutions, these pilot programs are important for countries to be able to optimize treatment options and improve patient safety. According to the World Health Organization (WHO) guidelines, determining the G6PD status of patients is crucial for guiding the administration of primaquine to prevent relapse in P. vivax malaria cases, and is a requirement for tafenoquine (TQ) as per its label. 

Representatives of each country currently rolling out the pilots shared unique challenges and lessons learned and celebrated achievements throughout the G6PD test implementation: 

• Colombia: Lina Zuluaga, from the University of Antioquia, highlighted that health personnel found the test easy to implement. Although patient acceptance to perform the test was high, the understanding of its importance was low. Lina stressed that this knowledge gap is expected and is part of an evolving process that requires additional time. 
• Guatemala: José Miguel Echeverría, from the MoH of Guatemala, expressed confidence about implementing G6PD testing in the coming years and added that the pilot could also help to improve the treatment of patients with P. vivax malaria: “Staff understood why it was necessary to be able to administer the test before malaria treatment, as this would help with patient safety. This motivated them to look for more cases and follow them up, improving patient care.” 
• Honduras: Lorenzo Pavón and Lesly Chaver, both from the MoH of Honduras, underscored the challenge of overcoming language barriers. In Gracias a Dios, the selected pilot site due to its high G6PD deficiency prevalence, the Miskito ethnic group speaks a native language, posing communication challenges.  
• Panama: Carmen Pérez, from the MoH of Panama, shared a different challenge faced by Panama—the rotation of personnel outside the initial plan. Despite this obstacle, staff who were already trained were able to support those who had not been yet, ensuring the continuity and success of the implementation. 

The Brazilian experience: national roll-out of tafenoquine (TQ) and G6PD testing 

The second panel focused on a recent significant milestone in Brazil: the incorporation of TQ and G6PD testing into the national public health system (SUS). Cássio Peterka, representing the Malaria Elimination Coordination at the Ministry of Health of Brazil, presented Brazil's nationwide strategic implementation plan for TQ and G6PD testing, addressing the status, upcoming steps, and challenges faced for the next phase. 

Cássio emphasized that half of the reported cases in Brazil are concentrated in indigenous and mining areas, where adherence to diagnosis and treatment poses significant challenges. "It is our duty as SUS and as the MoH to provide healthcare access to indigenous populations. Everyone in the Amazon has the right to be free from malaria. Let's forge ahead in reaching these communities,” he said. 

The MoH’s goal is to have these tools implemented across the entire country by the first half of 2026. 

Reaching special populations: challenges & efforts 

The last panel discussed the challenges and ongoing efforts to reach specific populations in Brazil, Colombia and Peru.  

• Brazil: Dr. André Siqueira, from Fiocruz, shed light on the public health emergency in Brazil's Yanomami region and border areas with Venezuela, where malaria-related deaths have surged due to insufficient diagnosis and healthcare access. He highlighted the need for long-lasting initiatives to eliminate malaria, interrupt illegal mining and improve access to health care for local community members. 
• Colombia: Iván Cárdenas, from the National Malaria Program at the MoH of Colombia, called for a collaborative effort between countries to support migrants in the Colombian border areas with Brazil, Paraguay, and Venezuela. He stressed that malaria hotspots track migration waves, which reinforces the need for joint initiatives using radical cure1 to address the vulnerabilities of these peoples on the move. 
• Peru: Cristiam Carey from the Loreto Health Coordination (Geresa Loreto) pointed out that Loreto is home to more than 90% of malaria cases in Peru and most of these cases affect children or adolescents. He highlighted that one of the challenges is ensuring adherence to a 7-day malaria treatment among this group. 

Regional coordination and the way forward 

The key role of regional coordination to drive efforts towards elimination was also addressed during the meeting. Dr. Roberto Montoya of PAHO highlighted that, to achieve the 75% caseload reduction goal for 2025, geographically targeted approaches to elimination and tools such as chemoprevention and new radical cure must be assessed. He also stressed the importance of understanding the gaps from a policy perspective, piloting innovative policies and implementing new approaches.  

PAVE representatives George Jagoe, from Medicines for Malaria Venture (MMV), and Gonzalo Domingo, from PATH, thanked the Bill & Melinda Gates Foundation (BMGF) for its founding energy and catalytic role in PAVE. As the funding support from BMGF comes to an end this year, the way that PAVE works will change. However, given the continued needs in the region, PAVE regional advisors will continue to support and provide technical assistance in this changing environment. With funding from Unitaid, the PAVE Peru feasibility study underway with TQ and G6PD testing in Peru will be finalized and Regional Meetings will continue in 2024 and 2025 as an opportunity to gather key stakeholders, share evidence, and latest developments on policy and strategy. They concluded by encouraging participants to identify opportunities for sustained collaborative work to reach elimination goals.