Improving the radical cure of vivax malaria: A multicentre randomised comparison of short and long course primaquine regimens

Lead Research Organisation: University of Oxford
Department Name: Tropical Medicine

Abstract

Plasmodium vivax malaria is a major cause of morbidity and an important contributor to mortality in poorly resourced endemic areas in Asia, South America and Africa. The greatest burden of vivax malaria is in South and Southeast Asia, where 2.85 billion people are at risk and experience 100 to 300 million cases of vivax malaria each year. Plasmodium vivax causes repetitive febrile illness associated with worsening anaemia particularly in young children and in pregnant women. Severe anaemia and low birth weight resulting in direct and indirect mortality. Despite the very large population affected by vivax malaria and its socioeconomic burden, it has been and continues to be a neglected disease; global malaria R&D spending on combating P. vivax amounted to just 3% of total spending on malaria between 2007-2009. Since the 1950s chloroquine has been the mainstay of treatment for acute vivax malaria. However resistance to chloroquine was first reported in Papua, Indonesia and there is now good evidence that it is prevalent across the Indonesian archipelago and has spread throughout much of the vivax endemic world.
Unlike Plasmodium falciparum, P. vivax has in addition to the blood stage a liver stage of the parasite (known as hypnozoite) capable of reawakening weeks or even months after the primary infection. The complete treatment of vivax malaria requires administration of antimalarials to eradicate both the blood and liver stages of the parasite. Primaquine remains the only drug on the market for its liver stage activity. However the efficacy of primaquine resistance is difficult to determine due to variable relapsing patterns of P. vivax and the need for prolonged follow up to capture the late relapses. The widespread use of primaquine has been severely limited because of concerns regarding both its efficacy and safety. Primaquine causes haemolysis in patients with G6PD deficiency, an inherited disorder occurring in 5-35% of patients in endemic zones. There a few readily available, affordable and reliable diagnostic tools for the rapid testing of GPD deficiency, and thus clinicians often reluctant to prescribe a therapy that is potentially harmful with limited perceived benefit. When it is prescribed adherence to the currently recommended 14 day treatment regimen is poor.
This proposal aims to provide critical evidence on the use of primaquine, a drug which is being increasingly recognised as a crucial tool in the global fight against malaria. We hypothesise that a shorter course high dose primaquine regimens will provide a practical approach to antirelapse therapy that is safe and effective. Our randomized placebo controlled multicentred trial will compare two different regimens of primaquine against schizontocidal treatment alone in 5 Asian countries. Trial centres will be established in South Asia (India, Pakistan and Afghanistan) where 70% of all cases occur and the interval between vivax relapses is relatively long, as well as two sites from South East Asia (Vietnam and Indonesia) where the interval between relapses is shorter and the risk of relapse greater.
The primary objective will be to compare two primaquine regimens giving the same total dose primaquine over either 7 or 14 days. Patients presenting with pure vivax malaria, meeting the inclusion criteria will be randomly assigned to receive one of the following three treatments:
Option 1 - Standard blood schizontocidal therapy + 14 days of supervised primaquine (7mg/kg total dose).
Option 2 - Standard blood schizontocidal therapy + 7 days of supervised primaquine (7mg/kg total dose).
Option 3 - Standard schizontocidal therapy. Treatment with primaquine will be deferred until the end of the follow up period. This is the control regimen.
Following treatment, patients will be followed for 12 months to monitor the number of vivax recurrences and the level of anaemia. Each recurrence of vivax malaria will be treated with the same allocated regimens.

Technical Summary

This is a multi-centre, open label, three-arm randomised non-inferiority trial to compare two primaquine anti-relapse regimens. The same total dose 7mg primaquine/kg will be given either over 14 or over 7 days. A control arm which receives only schizontocidal therapy without anti-relapse therapy will provide the comparison for safety, tolerability and relapse data.

Once randomised into one treatment arm the subject will receive the same prescribed regimen for subsequent recurrent vivax episodes throughout the 12 months follow-up period.

All potential study participants will be tested for G6PD deficiency. Patients identified as having G6PD deficiency will receive standard blood schizontocidal therapy plus 8 weeks of weekly primaquine dosing (7mg/kg total dose).

Planned Impact

The primary beneficiaries of the proposed trial are the 2.8 billion people at risk of infection by P. vivax and the 100 to 400 million patients who may be prescribed primaquine therapy against relapse. These patients would receive a regimen of therapy supported by clinical evidence of safety and efficacy, including, possibly, G6PDd patients, pregnant women, and small children now typically excluded from therapy for want of evidence of safety. The economic and societal impacts of these benefits will be diminished burdens of morbidity and mortality caused by this infection that would very likely follow with more aggressive advocacy for the application of primaquine therapy with the confidence of doing so without causing serious harm and with the greater certainty of deriving public health benefit that comes with proven efficacy. In many endemic areas, the successful application of primaquine in a single patient may avert secondary attacks, each attack coming with greater probability of severe illness and a potential for transmission. In short, this trial develops the necessary clinical evidence to support broad attack on the most significant reservoir of P. vivax.

The National Malaria Control Programmes (NMCP) of the countries where this study will take place will be major beneficiaries of the study. Our study seeks both to inform and involve policymakers and stakeholders in the early phase of the study so as to ensure local ownership. We will invite policymakers and stakeholders to planning meetings as early as possible and keep them updated about the progress of the study. On completion of the study, the implications and policy relevance of the results will be discussed with project partners, national policy makers, and representatives of local communities at a stakeholders' meeting. The efficacy and safety of high dose primaquine compared with the control arm will inform countries partners, on the risks and benefits of such a policy. Based on emerging consensus, policy-ready documents will be prepared and disseminated by the partners. It is anticipated that policy impact will occur within 6-12 months of study completion and will result in improved treatment guidelines for the delivery of antirelapse treatment regimens.

At a regional level, the importance of safe and effective radical cure of P. vivax has already been recognized by regional experts as a critical step in the control and elimination of malaria in the Asia-Pacific. Policy recommendations coming from the proposed trial will help develop better malaria control strategies for other Asian countries.

WHO reports and opinions influence regional policymakers. Several of the investigators of the proposed project participate in and on occasion chair WHO technical advisory groups on malaria chemotherapy. In their capacity as technical consultants they will feed back the results of this study not only to rationalise the risk benefits of primaquine therapy, as well as the experience gathered on the optimal study design of subsequent antirelapse studies. The data gathered on the safety of primaquine will inform the use of primaquine for both P. vivax radical cure and also P. falciparum transmission blocking regimens. Thus the evidence developed in this trial will improve the capacity of national malaria control programs to achieve elimination goals.

Research capacity in country research partner institutes will be enhanced by providing both short term and long term training and mentorship for research staff and students. The proposed project will build on existing trials capacity. Collaborative staff in the Mahidol Oxford University research Unit will provide support to write new proposals for research funding for studies beyond the end of the trial. Health worker capacity will be strengthened through training on the administration of antirelapse treatment, improving skills in malaria diagnosis and drug administration.

Publications

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Price RN (2020) Primaquine for Plasmodium vivax malaria treatment - Authors' reply. in Lancet (London, England)

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Commons RJ (2020) Estimating the Proportion of Plasmodium vivax Recurrences Caused by Relapse: A Systematic Review and Meta-Analysis. in The American journal of tropical medicine and hygiene

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Rosenthal PJ (2019) A shorter course for anti-relapse therapy against vivax malaria. in Lancet (London, England)

 
Description Indonesian policy makers at the Ministry of Health
Geographic Reach Asia 
Policy Influence Type Contribution to a national consultation/review
Impact Indonesian policy makers at the Ministry of Health, Centre for Disease Control and local Dinas Kesahatan are particularly interested in our studies. In March 2020, Indonesian PIs took part in a meeting with national policy makers regarding the strategic planning of malaria control and elimination in Indonesia. This meeting has set some key priorities for research agenda that have been set by local partners. Our primary Indonesian collaborator Dr Rini Poespoprodjo, has been invited to several meetings to present her findings on the use of ACTs in pregnancy. The interest in PQ7 (short course primaquine) now added as a national priority for implementation studies
 
Description PNG policy makers at the Ministry of Health
Geographic Reach Australia 
Policy Influence Type Contribution to a national consultation/review
Impact PNG currently uses low dose primaquine without G6PD testing. The results of the IMPROV trial show excellent efficacy with high dose short course primaquine. Feasibility studies now underway in PNG to assess whether this novel strategy can be used to change policy.
 
Description Effectiveness of novel approaches to radical cure of vivax malaria
Amount $1,599,228 (AUD)
Funding ID 1182950 
Organisation National Health and Medical Research Council 
Sector Public
Country Australia
Start 01/2020 
End 12/2025
 
Description Investigator Award
Amount $2,897,046 (AUD)
Funding ID GNT2008501 
Organisation Menzies School of Health Research 
Sector Academic/University
Country Australia
Start 01/2022 
End 12/2027
 
Description Project Grant
Amount $4,983,645 (USD)
Funding ID OPP1054404 
Organisation Bill and Melinda Gates Foundation 
Sector Charity/Non Profit
Country United States
Start 01/2013 
End 12/2019
 
Description Safe and Effective P. vivax Radical Cure (SEPRA)
Amount $525,000 (USD)
Funding ID INV-024389 
Organisation Bill and Melinda Gates Foundation 
Sector Charity/Non Profit
Country United States
Start 11/2020 
End 12/2023
 
Description Wellcome Trust Senior Research Fellowship in Clinical Science
Amount £1,406,829 (GBP)
Funding ID 200909/Z/16/Z 
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 08/2016 
End 08/2021
 
Title Better methods for costing costs of P. vivax malaria 
Description Analysis from IMPROV data to define costs of malaria episodes. Paper "Provider and household costs of Plasmodium vivax malaria episodes: a multicountry comparative analysis of primary trial data" Bulletin of WHO, 97(12):828-836, 2019. 
Type Of Material Physiological assessment or outcome measure 
Year Produced 2019 
Provided To Others? Yes  
Impact Framework for analyses of cost effectiveness of novel strategies for Pvivax radical cure 
 
Title Ethical Dilemma of the use of Placebo in primaquine trials 
Description The IMPROV study presents an ethical dilemma regarding the use of placebo in patients who could be prescribed Primaquine radical cure. Our team has explored these issues and presented a review of the challenges. (BMC Medical Ethics 2018). 
Type Of Material Improvements to research infrastructure 
Year Produced 2018 
Provided To Others? Yes  
Impact Cheah et al. The ethics of using placebo in randomised controlled trials: a case study of a Plasmodium vivax antirelapse trial. BMC Medical Ethics, in Press 2018. We believe that the use of placebo is justified and indeed necessary if the trials results are to be informative. 
 
Title Database of provider and patient cost data generated by the IMPROV study. 
Description An analysis of provider and patient cost data generated by the IMPROV study. These data are summarised and provided open access in a paper Devine et al . Provider and household costs of Plasmodium vivax malaria episodes: a multicountry comparative analysis of primary trial data. Bulletin of WHO, 97(12):828-836, 2019. 
Type Of Material Database/Collection of data 
Year Produced 2019 
Provided To Others? Yes  
Impact The cost data for patient and provdiers for P. vivax malaria represent the most comprehensive data available to date and will underpin future analyses of the global burden of vivax malaria and the cost effectiveness not only of G6PD testing and short course primaquine but many other proposed interventions. 
URL http://dx.doi.org/10.2471/BLT.18.226688
 
Description Addis Ababa University 
Organisation Addis Ababa University
Country Ethiopia 
Sector Academic/University 
PI Contribution Addis Ababa University is conducting the trial at a site in Arba Minch, Ethiopia
Collaborator Contribution Addis Ababa University is conducting the trial at a site in Arba Minch, Ethiopia
Impact Keys partners in antimalarial clinical trials conducted in Arba Minch (southern Ethiopia). Including IMPROV, PRIMA and EFFORT. All exploring high dose short course primaquine
Start Year 2016
 
Description Bill and Melinda Gates Foundation 
Organisation Bill and Melinda Gates Foundation
Country United States 
Sector Charity/Non Profit 
PI Contribution The BMGF are funding OPRA which is linked to the IMPROV funding stream.
Collaborator Contribution The BMGF are funding OPRA which is linked to the IMPROV funding stream.
Impact Publications and conference presentations. Research ongoing.
Start Year 2012
 
Description EOCRU 
Organisation Eijkman Oxford Clinical Research Unit
Country Indonesia 
Sector Hospitals 
PI Contribution EOCRU are conducting the IMPROV clinical trial at a site in North Sumatra
Collaborator Contribution EOCRU are conducting the IMPROV clinical trial at a site in North Sumatra
Impact Publication of the trial protocol. Trial follow ups have just finished and data analysis will commence soon once all data has been cleaned. Attendance and presentation at the international meeting of the Asia Pacific Malaria Elimination Network (APMEN) in October 2017.
Start Year 2014
 
Description EPHI 
Organisation Ethiopian Public Health Institute
Country Ethiopia 
Sector Public 
PI Contribution EPHI are conducting the trial at a site in Metehara, Ethiopia
Collaborator Contribution EPHI are conducting the trial at a site in Metehara, Ethiopia
Impact Several large clinical trials including the IMPROV Study and Abreha et al. We continue to work closely with EPHI on trials informing national antimalarial policy.
Start Year 2016
 
Description Eijkman Institute of Molecular Biology 
Organisation Government of Indonesia
Country Indonesia 
Sector Public 
PI Contribution I am working with Kevin Baird at the Eijkman Institute of Molecular Biology in Jakarta on antirelapse clinical efficacy trials for short course high dose primaquine. I am also working with Dr Rintis Noviyanti on molecular genotyping of P. vivax.
Collaborator Contribution N/A
Impact About 2-4 publications per year
Start Year 2011
 
Description Eijkman Oxford Clinical Research Unit 
Organisation University of Oxford
Department Oxford University Clinical Research Unit Vietnam (OUCRU)
Country Viet Nam 
Sector Academic/University 
PI Contribution EOUCRU are conducting the clinical trial at the South Sumatra site
Collaborator Contribution EOUCRU are conducting the clinical trial at the South Sumatra site
Impact Kevin Baird and EOUCRU in Jakarta, continue to be active collaborators on clinical trials and individual patient data metanalyses.
Start Year 2014
 
Description HPRO 
Organisation Health Protection and Research Organisation (HPRO)
Country Afghanistan 
Sector Public 
PI Contribution HPRO are conducting the trial at one of the sites in Afghanistan
Collaborator Contribution HPRO are conducting the trial at one of the sites in Afghanistan
Impact Partners conducting IMPROV study in Afghanistan. Ongoing collaborations writing up subprojects on safety and G6PDd
Start Year 2013
 
Description HSDO 
Organisation Health Care and Social Development Organization
Country Uganda 
Sector Charity/Non Profit 
PI Contribution HSDO are conducting the clinical trial at one of the sites in Afghanistan.
Collaborator Contribution HSDO are conducting the clinical trial at one of the sites in Afghanistan.
Impact Partners conducting IMPROV study in Afghanistan. Ongoing collaborations writing up subprojects on safety and G6PD deficiency
Start Year 2013
 
Description IMPROV OPRA 
Organisation Charles Darwin University (CDU)
Country Australia 
Sector Academic/University 
PI Contribution Linked to the IMPROV funding stream. IMPROV is delivered through Oxford and OPRA through Menzies School of Health Research.
Collaborator Contribution Linked to the IMPROV funding stream. IMPROV is delivered through Oxford and OPRA through Menzies School of Health Research.
Impact TBC
Start Year 2013
 
Description IMPROV Study 
Organisation Wellcome Trust
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution I am working with Professor Day and White on the delivery of the IMPROV study and connected auxiliary studies.
Collaborator Contribution MORU are providing clinical trials and laboratory support for conducting the multicentred IMPROV study.
Impact TBC
 
Description Mahidol-Oxford Tropical Medicine Research Unit (MORU) 
Organisation Wellcome Trust
Department Mahidol University-Oxford Tropical Medicine Research Programme
Country United Kingdom 
Sector Academic/University 
PI Contribution Collaborating on IMPROV and OPRA projects
Collaborator Contribution Collaborating on IMPROV and OPRA projects
Impact Publications, conference presentations. Ongoing research.
Start Year 2011
 
Description University of Melbourne 
Organisation University of Melbourne
Country Australia 
Sector Academic/University 
PI Contribution The team at the University of Melbourne is assisting with the Statistical Plan and statistical analysis for the IMPROV trial.
Collaborator Contribution The team at the University of Melbourne is assisting with the Statistical Plan and statistical analysis for the IMPROV trial.
Impact The team works on the statistical analysis for malaria clinical trials and metanalyses
Start Year 2014
 
Title Effectiveness of novel approaches to radical cure with tafenoquine and primaquine 
Description IMPROV Study highlighted that 7 day primaquine was equivalnce to 14 days regimen, but will it has superior effectiveness. The EFFORT Trial has been funded by NHMRC to explore this and also compare to single dose of tafenoquine. Study underway in Bangladesh, Ethiopia, Indonesia and Pakistan. 
Type Therapeutic Intervention - Drug
Current Stage Of Development Late clinical evaluation
Year Development Stage Completed 2022
Development Status Under active development/distribution
Clinical Trial? Yes
Impact The ongoing study, initiated after IMPROV study, will explore safety of PQ7 and whether it offers better effectiveness over current standard of care. If confirmed this trial is set to change national and international policy 
URL https://www.menzies.edu.au/page/Research/Projects/Malaria/EFFORT_clinical_trial_Effectiveness_of_taf...
 
Title PRIMA study exploring the role of radical cure for patients with P. falciparim 
Description Pooled analyses have shown a high risk of Pvivax after Pfalciparum, this is a major cause of recurrence and ongoing transmission. A large cluster study in Papua (TRIPI funded by Wellcome Fellowship) showed benefits of universal radical cure to all patients with malaria. (Poespoprodjo et al Lancet ID 2022 doi: 10.1016/S1473-3099(21)00358-3) THe PRIMA study follows in from TRIPI and IMPROV, exploring high dose short course primaquine vs single dose pq for patients with P.falciparum Funded by Australian Academy of Science and Bill Melinda Gates FOundation. 
Type Therapeutic Intervention - Drug
Current Stage Of Development Late clinical evaluation
Year Development Stage Completed 2022
Development Status Under active development/distribution
Clinical Trial? Yes
Impact This novel trial offers a potential paradigm shift in the treatment of malaria. Targeting the hidden reservoir of Pvivax hypnzoites in patients presenting with Pfalciparum. 
URL https://www.menzies.edu.au/page/Research/Projects/Malaria/PRIMA_clinical_trial_Universal_Radical_Cur...
 
Description ACREME - Webinar. 11th June 2020 Presentation by Kamala Thriemer 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Australian Centre of Research Excellence. Webinar presentation on "Clinical trials to improve radical cure of vivax malaria". To highlight follow on studies from IMPROV study
Year(s) Of Engagement Activity 2020
 
Description APMEN TechTalks Webinar 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Workshop for the Asia Pacific Malaria Elimination Network on "Optimizing radical cure for vivax malaria: Informing policy and practice" by RN Price
Year(s) Of Engagement Activity 2021
 
Description APMEN Vivax Working Group (VxWG) meeting in Kathmandu - 2019 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact The Asia Pacific Malaria Elimination Network conducted a 3 day meeting attended by representative of the National Malaria Control Programs (NMCPs) of 18 malaria endemic countries to discuss how to achieve radical cure of P. vivax. A day long workshop was conducted during which country partners discussed the IMPROV results and what further evidence was needed for policy change.
Year(s) Of Engagement Activity 2019
 
Description APMEN Webinar 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact A webinar on 3rd July 2020 "Optimizing radical cure for vivax malaria: Informing policy and practice". Attended by researchers, national malaria control porgrams and policy makers. Presentations on alternative strategies for radical cure including short course high dose primaquine.
Year(s) Of Engagement Activity 2020
 
Description American Society of Tropical Medicine 68th Annual Meeting - Special Symposium - Nov 2019 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact A talk by RN Price entitled "Optimizing Radical Cure of Vivax Malaria in the Era of Tafenoquine". Highlighting issues of adherence and high efficacy of 7 days primaquine
Year(s) Of Engagement Activity 2019
 
Description Ethiopian stakeholder meeting 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact An Ethiopian stakeholder meeting was convened in November 2019. To present the results of IMPROV study.
It was attanded by representatives from the NMCP, the Technical Advisory Group, WHO, Malaria Consortium, PATH, Addis Continental Institute of Public Health, and the Ethiopian Public Health Institute
Year(s) Of Engagement Activity 2019
 
Description Forum on Operational Research in the Context of the Last Mile of Malaria Elimination in GMS Countries - 24th Nov 2020 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Virtual Meeting 24-25 November 2020. RN Price presentation of "Effectiveness of novel approaches to radical cure with tafenoquine and primaquine"
Year(s) Of Engagement Activity 2020
 
Description IMPROV Investigator Meeting 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact The Principal Investigator, Site investigators, Trial Management Group, and analysis team of the IMPROV study met over 2 days in Bangkok, Thailand to report on field site experiences, discuss the results of the primary analysis, make a plan for the main publication and discuss subprojects. This was followed by a 2-day meeting of the main investigators, clinical and analysis team to draft the main manuscript.
Year(s) Of Engagement Activity 2018
 
Description Indonesian Webinar - Parasitic Diseases Control Association. Future Research on Malaria - 2020 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact An Indonesian webinar series. August 19th, 2020. Jakarta, Indonesia.
Invtation to speak about "Challenges in Vivax Malaria Elimination in Indonesia" including issues of adherence and short course primaquine regimens.
Year(s) Of Engagement Activity 2020
 
Description Indonesian National Malaria Expert Committee - 2019 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Two site investigators from Indonesia attended the National Expert Malaria committee, where IMPROV results were presented and discussed.
Indonesia NMCP is now considering feasibility studies to explore the use of G6PD testing and short course primaquine.
Year(s) Of Engagement Activity 2019
 
Description Indonesian Workshop - Promoting the safe radical cure of P. vivax. 2016 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The IMPROV research protocols and issues being addressed on the use of primaquine have been raised at two international meetings of the Asia Pacific Malaria Elimination Network (APMEN). The Vivax Working Group includes representatives of the National Malaria Control Programs of 18 malaria endemic countries, as well as policy makers, healthcare workers, researchers, public private partnerships, industry and other complementary networks.is included a workshop.
Year(s) Of Engagement Activity 2016
 
Description Indonesian Workshop - Tackling Effective Radical Cure of P. vivax. 2017 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The IMPROV research protocols and issues being addressed on the use of primaquine have been raised at two international meetings of the Asia Pacific Malaria Elimination Network (APMEN). The Vivax Working Group includes representatives of the National Malaria Control Programs of 18 malaria endemic countries, as well as policy makers, healthcare workers, researchers, public private partnerships, industry and other complementary networks.is included a workshop. This workshop discussed the principal issues regarding primaquine effectiveness and the need for shorter regimens.
Year(s) Of Engagement Activity 2017
 
Description Joint International Tropical Medicine Meeting (JITMM). - 16th Dec 2020 Presentation by Kamala Thriemer 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact "Improving primaquine treatment for P. vivax malaria" highlighting potential of short course primaquine
Year(s) Of Engagement Activity 2020
 
Description Keystone Conference - Malaria: Confronting Challenges From Drug Discovery to Treatment - 2022 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Invited speaker Presentation on "Novel approaches for the safe and effective radical cure of P. vivax" by RN Price
Year(s) Of Engagement Activity 2022
 
Description Keystone Symposia Conference on Molecular and Cellular Biology 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact This was a high profile meeting in Addis Ababa with a presentation of the results of IMPROV study to an audience of policy makers and researchers from Across Africa.
Highlighted the utility of radical cure and safety of a 7 day regimen.
Year(s) Of Engagement Activity 2019
 
Description Special Symposium of the ASTMH Annual Meeting 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact The IMPROV team presented the results of the IMPROV study at a special symposium of the 67th ASTMH Annual Meeting on November 1, 2018 in New Orleans.
Year(s) Of Engagement Activity 2018