Dissemination of EFFORT trial results in Indonesia: a stakeholder meeting report on tafenoquine and primaquine for radical cure of Plasmodium vivax

Abstract

The EFFORT clinical trial was conducted in four countries (Cambodia, Ethiopia, Indonesia, and Pakistan) to evaluate the safety and effectiveness of high-dose primaquine (7 mg/kg over 7 days) and single-dose tafenoquine (300 mg) compared with the standard 14-day low-dose primaquine regimen for the radical cure of patients with Plasmodium vivax malaria. In Indonesia, both regimens were co-administered with dihydroartemisinin-piperaquine. This paper reports on a national stakeholder meeting held in May 2025 to disseminate Indonesia-specific findings and discuss their implications for malaria control and elimination policy. Discussions centred on (i) the evidence gaps regarding tafenoquine when combined with artemisinin combination therapies (ACTs), (ii) the feasibility of implementing high-dose primaquine in Indonesia as a near-term option, and (iii) the need for subnational strategies that reflect the country's diverse epidemiological context. Stakeholders highlighted the need for further studies on tafenoquine with ACTs, while recognising high-dose primaquine as an immediately implementable option pending strengthened G6PD testing. The discussion emphasised the importance of tailoring strategies to Indonesia's diverse settings, supported by strong political commitment to elimination.