Implementing Primaquine Single Low Dose in Africa

ongoing

The 2021 World Malaria Report estimates that the number of clinical cases in 2020 was 241 million and the number of deaths was 627,000, an increase of 69,000 compared to 2019, a timely reminder to maintain good malaria control and introduce novel elimination strategies. In 2012, to further reduce malaria transmission and possibly reach elimination, the WHO recommended adding single low dose primaquine (SLDPQ) to artemisinin based treatments (ACTs) in low transmission settings and more recently in areas where artemisinin resistance is emerging. SLDPQ kills mature gametocytes, blocking the transmission between humans and mosquitoes and should see a reduction in the malaria burden with widespread deployment. Compounding the poor uptake of SLDPQ is the lack of child-friendly formulations of primaquine and lingering anxieties regarding primaquine-related acute haemolysis in patients with glucose-6-phosphate dehydrogenase deficiency. Building on the good progress of the ‘Developing Paediatric Primaquine’ EDCTP2-funded project, aiming at prequalifying paediatric formulations, we have conceived the IMPRIMA project to support the adoption of SLDPQ by conducting a real-life implementation study using our flavoured primaquine for children. Key to our success is the unique triangle of interconnecting activities - clinical, community/sociological, and policy - all within a matrix of capacity building and strong coordination by all seven partners. Our ambitious proposal aims to demonstrate the safety, acceptability, and community benefit of SLDPQ in 3 African countries with different malaria epidemiologies. Engagement with the communities and policy makers are fundamental to effect a positive change in drug policy and contribute to malaria elimination. In parallel, capacity will be enhanced for conducting clinical trials and monitoring the evolution of antimalarial drugs resistance. We believe the IMPRIMA project fits extremely well with the priorities of this call.