Revisiting Raquel: Single-dose tafenoquine for P. vivax malaria

Raquel da Silva, pictured above with her son Camilinho, has lived in Manaus in Brazil’s Amazonas State since her childhood. Today she shares her home on the banks of the Rio Negro with her husband Camilo, their three children, her mother-in-law and her grandmother-in-law. On the weekends, she works in a restaurant.

As a mother of three, Raquel needs her energy to keep up with her children, but living in one of the most malaria-affected areas in the country she has been ill with the disease many times. She has lost track of how many times she has contracted malaria but estimates it must be at least a dozen. In 2022 alone, she got sick with malaria at least three times: twice with Plasmodium falciparum malaria and once with P. vivax malaria, which is more common in Latin America.

The first time MMV met Raquel in 2020, she was unwell. At the time, P. vivax malaria required a full 7-day treatment to cure and prevent relapse, and since she had a 6-month-old baby at home and her husband was away working, she felt unable to complete the full treatment course. “I took just enough so my symptoms would improve.” She dealt with many bouts of the illness, accompanied by low energy, chills and fever.

In 2022, however, things were different. When she got malaria, she received a new drug: tafenoquine. Developed in partnership between GSK and MMV, this drug is a single-dose radical cure for P. vivax malaria, meaning that it prevents relapse when accompanied by chloroquine, an antimalarial drug already widely distributed and used in Brazil’s health system.

Manaus, where Raquel lives, and Porto Velho are the only cities in Brazil authorized by the Brazilian Ministry of Health to prescribe tafenoquine after quantitative point-of-care G6PD testing as part of a temporary implementation plan in the national public health system. This implementation is accompanied by the MoH and MMV-co-sponsored Tafenoquine Roll-out STudy (TRuST), described above.

For patients with normal G6PD enzyme activity, the new treatment protocol with tafenoquine is much simpler, something that makes a big difference in the lives of patients like Raquel.

Raquel is optimistic about the new possibilities that the drug provides. She says that, although she also takes preventive measures such as using bed nets, the drug provides a sense of security in case she or her family members do fall ill again.