Radical cure for malaria among highly mobile and hard-to-reach populations on the Guyanese shield (CUREMA)

The persistence of infections by P. vivax remains a challenge for the elimination of malaria due, among other factors, to the biology of the parasite. This challenge is even greater in remote, mobile and hard-to-reach populations, such as the garimpeiros who work in an irregular situation in the Guiana shield. The group recently carried out the Malakit project, an intervention targeting the P. falciparum reservoir among garimpeiros on the French Guiana border. This strategy consisted of distributing self-test and self-treatment kits for P. falciparum malaria. The evaluation of this innovative strategy showed that free training and the distribution of kits effectively improved behavior: the proportion of miners who took adequate treatment in case of malaria symptoms (with full adherence, and started only after a positive test) increased significantly (OR = 1.8, 95% CWE [1.1-3.0]). The intervention appears to have contributed to the reduction of malaria transmission in the region by 43%. However, this intervention did not offer a solution to the risk of spontaneous recurrences (relapses) of P. vivax: the last, and probably the most difficult parasite to eliminate. The intervention will have an effect on: asymptomatic patients carrying P. vivax hypnozoites, with radical cure of asymptomatic and symptomatic individuals identified as at risk (Module A), and malaria cases in extremely remote areas far from the health system, with distribution of a self-test and self-treatment kit (Module B).

ClinicalTrials.gov ID: NCT05540470

This study intervention is made up of two modules of which participants can choose between participating in one or both modules:

• Module A of the intervention will be treatment targeting asymptomatic individuals at risk of carrying P. vivax. The aim of this module is to prevent relapses and reduce the number of human hosts able to transmit the parasite.
  • Blood stage treatment: chloroquine (CQ) (600mgs on 1st day, 450mgs on 2nd and 300mgs on 3rd day, or weight-adjusted dosing)
  • Liver stage treatment either; primaquine (PQ) (in a short regimen of 30 mg/day for 7 days or tafenoquine (TQ) (300 mg single dose), after exclusion of contraindications to these treatments
• Module B of the intervention will correspond to the provision, after appropriate training, of a Malakit self-test and self-treatment kit. The aim of this module is to provide access to quality diagnosis and treatment for episodes of symptoms consistent with malaria that occur in situations of extreme remoteness from health services.

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P. vivax
Residual Transmission

Feb 2022 — Feb 2025

Brazil
Suriname