- Tribhuvan University, Kathmandu, Nepal
- Department of Health Services, Ministry of Health and Population, Nepal
- Australian Academy of Science
- Bill and Melinda Gates Foundation
- Pearl Gan in association with OUCRU, Vietnam and EOCRU, Indonesia.
Short course radical cure of P. vivax in Nepal - a randomized controlled trial – pilot study (SIRIN)
To simplify malaria treatment in Nepal by reducing the treatment course of primaquine radical cure for P. vivax malaria.
The current regimen for P. vivax radical cure requires a 14-day course of primaquine, but the long course of treatment means that many patients don’t complete their medication and thus fail treatment.
In Nepal recent evidence suggests that a low dose regimen of 3.5mg/kg total dose is effective in preventing recurrent episodes of vivax malaria1. Shortening this course is likely to increase adherence and therefore effectiveness.
In addition, in co-endemic areas, up to half of patients treated for P. falciparum malaria representing with P. vivax malaria 2,3. We hypothesize that this is due to the P. falciparum parasite triggering a P. vivax relapse. Hence, in some co-endemic regions there is a good rationale for eradicating P. vivax hypnozoites from the liver in patients presenting with uncomplicated P. falciparum infections. In close collaboration with the Nepal National Malaria Program we are conducting a randomized, open label pilot study to assess the safety and efficacy of a shortened PQ treatment (3.5mg/kg total dose given over 7 days) in G6PD normal patients with P. vivax and P. falciparum to reduce the risk of subsequent P. vivax episodes.
Implications for policy and practice:
Shortening the course and providing unified treatment options for malaria is likely to have programmatic advantages and could reduce the burden of malaria in Nepal, delivering a large public health benefit.
Short course radical cure of P. vivax in Nepal - a randomized controlled trial – pilot study.
Assess the efficacy of a 7-day low dose course of primaquine (3.5mg/kg total dose) for the radical cure of P. vivax malaria in mixed malaria infections.
- To assess the safety and efficacy of a 7-day course of primaquine in preventing recurrent symptomatic P. vivax in G6PD normal patients following uncomplicated P. vivax and P. falciparum malaria.
- To assess the efficacy of a 7-day course of primaquine in preventing recurrent symptomatic and asymptomatic P. vivax parasitaemia
- To assess the safety of a 7-day course of primaquine treatment
For more information visit the clinical trials website.
The trial will commence in March 2020.
- Contact Sophie Weston for further information about the study.
- Dr Prakash Ghimire, Tribhuvan University, Nepal
- Dr Bibek Lal, National Malaria Control Program, Department of Health Services, Ministry of Health and Population, Nepal
- Dr Benedikt Ley, Menzies School of Health Research
- Professor Ric Price, Menzies School of Health Research