The APMEN VxWG Annual Meeting 2019 was held in Kathmandu, Nepal.

The Annual Meeting drew more than 150 participants representing 18 APMEN Country Partners and Partner Institutions, along with active participation from other observers in attendance. The Vivax working group meeting brought together key stakeholders from National Malaria Control Programs, academics, private-public partnerships, funders and the World Health Organisation.

Updates on diagnostics and treatment were presented, with particular attention to the implementation of novel radical cure options. The two-day meeting was followed by a one day workshop with country partners to develop roadmaps towards implementation.

Day  One: Tools And Strategies For The Implementation Of Safe Radical Cure

Country partners were provided with an update on recent advances in diagnostics for patients with G6PD deficiency and vivax malaria and novel treatment options (including short course high dose primaquine and tafenoquine).  Cost effectiveness analyses on G6Pd testing and radical cure were also presented. Following these updates, round table discussions were held to review evidence gaps and key questions that needed to be addressed to move towards policy change for safer and more effective radical cure. Key issues raised included better data on the comparative effectiveness of different radical cure options, the reliability, feasibility and cost-effectiveness of novel diagnostics in clinical practice, and other operational questions. An in-depth analysis of this round table discussion will be made available in the coming months, to encourage alignment of research agendas with country needs.

• Introductions  and overview of the meeting - Ric Price 
• Updates on  G6PD diagnostics  – Preecha Prempree
• Carestart  G6PD RDT meta-analysis  – Ari Winasti Satyagraha
• G6PD testing  – the WHO perspective – Jane Cunningham  
• Update on P.  vivax diagnostics – Ros Howes 
• Safety and  efficacy of a short and high dose PQ regimen – results of the IMPROV study – Ayodhia Pitaloka  
• Tafenoquine  Update – Andre Siquera/ Andy Walker
• Implementing  safe and effective radical cure – what are the options? – Kamala Thriemer
• An online  model to investigate the cost-effectiveness of G6PD screening for radical cure – Angela Devine

Day Two: Implementing  Safe And Effective Radical Cure

On the second day participants of NMCPs from Nepal, Cambodia, Thailand, PNG, Lao and Vietnam presented national challenges and country specific solutions. This was an opportunity for south-south collaboration and learning from areas at similar stages of the elimination journey. The presentations were complemented by a series of round table gatherings designed to share expert knowledge on the following operational topics: pharmacovigilance & surveillance, training, supply chain & procurement, financing and advocacy.

• Nepal  – the challenge of vivax malaria and implementation of routine qualitative G6PD  testing– Bibek Kumar Lal & Prakash Ghimire
• Cambodia – update on current progress – Lek Desoley
• Thailand  – methods & pharmacovigilance for the introduction of TQ – Darin Areechokchai
• Introduction  into critical topics in safe and effective radical cure implementation  (pharmacovigilance & surveillance, training, supply chain & procurement,  financing, advocacy etc.) – Spike Nowak
• Results  from Landscaping in PNG – Livingston Tavul & Leo Makita
• Biosensor  usability study in Laos – Keobuphaphone Chindavongsa
• Results  readiness planning exercise Vietnam – Ngo Duc Thang

Business  meeting

• Report on  VxWG Activities  – Ric Price
• New APMEN  Governance Structure  – Amita Chebbi

Day Three –  Workshop with NMCPs

Day 3 NMCP Workshop: This workshop set out to develop country-specific roadmaps for implementing changes in policy and practice for safer and more effective radical cure. In-depth conversations between 2-3 countries, were held to identify the specific needs of each program and the formal processes to change policy in each country were mapped. The different needs for introducing PQ and TQ were explored. Participants then revisited the topic around evidence gaps discussed on Day2 and refined and prioritised the relevant questions. Cost-effectiveness models were then generated with country-specific data. In the afternoon country partners develop timelines for countries to accelerate the implementation of novel strategies for radical cure.