@article{5aae0d5db7b44066b037c05bde181ec0,
title = "Rationale for short course primaquine in Africa to interrupt malaria transmission",
abstract = "Following the recent successes of malaria control in sub-Saharan Africa, the gametocytocidal drug primaquine needs evaluation as a tool to further reduce the transmission of Plasmodium falciparum malaria. The drug has scarcely been used in Africa because of concerns about its safety in people with glucose-6-phosphate dehydrogenase (G6PD) deficiency. The evidence base for the use of primaquine as a transmission blocker is limited by a lack of comparable clinical and parasitological endpoints between trials. In March 2012, a group of experts met in London to discuss the existing evidence on the ability of primaquine to block malaria transmission, to define the roadblocks to the use of primaquine in Africa and to develop a roadmap to enable its rapid, safe and effective deployment. The output of this meeting is a strategic plan to optimize trial design to reach desired goals efficiently. The roadmap includes suggestions for a series of phase 1, 2, 3 and 4 studies to address specific hurdles to primaquines deployment. These include ex-vivo studies on efficacy, primaquine pharmacokinetics and pharmacodynamics and dose escalation studies for safety in high-risk groups. Phase 3 community trials are proposed, along with Phase 4 studies to evaluate safety, particularly in pregnancy, through pharmacovigilance in areas where primaquine is already deployed. In parallel, efforts need to be made to address issues in drug supply and regulation, to map G6PD deficiency and to support the evaluation of alternative gametocytocidal compounds.",
keywords = "8-aminoquinoline, Africa, G6PD, Gametocyte, Glucose-6-phosphate dehydrogenase deficiency, Malaria, Plasmodium falciparum, Primaquine, Transmission",
author = "Eziefula, {Alice C.} and Roly Gosling and Jimee Hwang and Hsiang, {Michelle S.} and Teun Bousema and {Von Seidlein}, Lorenz and Chris Drakeley",
note = "Funding Information: The authors are thankful for the positive and lively discussion of all the attendees who form the Primaquine in Africa Discussion Group. These were Salhiya Ali National Malaria Control Programme, Zanzibar), Keith Arnold (University Medical Schools, USA; Saigon University, Vietnam & Chinese University, China), Ashenafi Assefa (Ministry of Health, Ethiopia), Kevin Baird (The Eijkman-Oxford Clinical Research Unit, Indonesia), Karen Barnes (Medical Research Council, South Africa), Teun Bousema (Radboud University Nijmegen Medical Centre, The Netherlands and London School of Hygiene and Tropical Medicine, UK), Janice Culpepper (Bill and Melinda Gates Foundation, USA), Karen Day (New York University, USA), Diadier Diallo (Institute de Recherche en Sciences de la Sant{\'e}—Direction R{\'e}gionale de l{\textquoteright}Ouest [IRSS-DRO], Burkina Faso), Susan Dixon (GlaxoSmithKline, UK), Gonzalo Domingo (PATH, USA), Chris Drakeley (London School of Hygiene and Tropical Medicine, UK), Alice Chi Eziefula (London School of Hygiene and Tropical Medicine, UK), Roly Gosling (University of California, San Francisco, USA), Justin Green (GlaxoSmithKline, UK), Brian Greenwood (London School of Hygiene and Tropical Medicine, UK), Heiner Grueninger (Novartis, Switzerland), Rosalind Howes (University of Oxford, UK), Michelle Hsiang (University of California, San Francisco), Jimee Hwang (Centers for Disease Control and Prevention, USA), Patrick Kachur (Centers for Disease Control and Prevention, USA), Akira Kaneko (Osaka University Medical School, Japan and Karolinska University Hospital, Sweden), David McGibney (Medicines for Malaria Venture, Geneva), Olaf Mueller (Heidelberg University Hospital, Germany), Joseph Okebe (Medical Research Council, The Gambia and Prince Leopold Institute of Tropical Medicine, Belgium), Pascal Ringwald (World Health Organization, Geneva), Dennis Shanks (Army Malaria Institute, Australia), Erin Shutes (Bill and Melinda Gates Foundation, USA), Lorenz von Seidlein (Menzies School of Health Research, Australia), David Warhurst (London School of Hygiene and Tropical Medicine, UK). Umberto D{\textquoteright}Alessandro (Prince Leopold Institute of Tropical Medicine, Belgium and Medical Research Council, The Gambia), Guoqiao Li (Saigon University, Vietnam & Chinese University, China), Alan McGill, Lucy Okell (Imperial College London, UK) and Seif Shekelaghe (Ifakara Health Institute, Tanzania) were unable to attend but provided important contributions. The authors would like to thank Dalia Iskander (London School of Hygiene and Tropical Medicine, UK) for logistical support and the Bill and Melinda Gates Foundation, The Global Health Group at the University of San Francisco in California and the Malaria Centre at the London School of Hygiene and Tropical Medicine for financial support. Alice C. Eziefula is funded by a Clinical Fellowship from the Wellcome Trust of Great Britain (#090558/Z/09/Z).",
year = "2012",
doi = "10.1186/1475-2875-11-360",
language = "English (US)",
volume = "11",
journal = "Malaria journal",
issn = "1475-2875",
publisher = "BioMed Central",
}