Document Type

DNP Project

Department

School of Nursing

Date of Degree

Spring 2018

Degree

Doctor of Nursing Practice (DNP)

Primary Advisor

Qiuping (Pearl) Zhou, Ashley Darcy-Mahoney

Keywords

Malaria, G6PD, Primaquine, Rapid Diagnostic Test

Abstract

Background: Primaquine (PQ) is the only FDA-approved drug for radical cure of Plasmodium vivax (P.v) malaria, but treatment can result in life-threatening hemolysis if given to a glucose-6- phosphate dehydrogenase deficient (G6PDd) patient. Therefore, the G6PD status of the patient with P.v must be known prior to prescribing PQ. However, patient G6PD status in rural malaria endemic settings is generally unknown, illuminating the need for reliable point of care G6PD diagnostic tests as a prerequisite to safely administer PQ. To increase community PQ access in Cambodia, performance of CareStartTM G6PD rapid diagnostic tests (RDTs) needs to be evaluated in healthcare workers (HCWs) and village malaria workers (VMWs).

Methods: Training materials on G6PD and PQ were developed for HCWs and VMWs and each performed G6PD RDT test on 8-12 adult male volunteers, with pre- and post-training questionnaires completed by trainees and G6PD test volunteers. The performance of CareStartTM RDT for G6PDd screening was assessed against a quantitative G6PD lab test (Pointe Scientific, Inc. MI, USA). Descriptive and inferential statistics were used to analyze the data.

Results: 94 trainees and 960 G6PD volunteers were recruited in Oddar Meanchey province, Cambodia from December 2017 to February 2018. Of the 960 volunteers, 156 (16%) were G6PD deficient based on a quantitative test activity threshold of 30%. The sensitivity, specificity, PPV and NPV of CareStart™ RDT were 96.8%, 95.5%, 80.2%, 99.4% for HCW/VMW trainees vs. 96.2%, 97.2%, 86.7%, and 99.3% for trained study staff in the field and 94.2%, 98.8%, 93.6% and 98.92% for experienced laboratory staff, with no statistical difference among the groups. The mean knowledge score pre-training was 33.9% (VMWs) and 56.4% (HCWs), with improvement to 89% and 90% post training (p

Conclusions: With minimal training, CareStart™ RDT is highly specific, feasible and a practical option for the identification of G6PDd male patients and its use may enable safer prescribing of PQ to decrease the burden of P.v relapse.

Patient Counseling Script on G6PD_BWojnarski.pdf (1621 kB)
Patient Counseling Script

Open Access

1

Available for download on Wednesday, October 17, 2018

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