Suboptimal primaquine adherence in Plasmodium vivax malaria: Evidence from high-burden tribal districts in Odisha

Suboptimal primaquine adherence delays P. vivax elimination despite adequate drug supply and correct dosing. Addressing behavioral drivers of early treatment cessation is critical to interrupt relapse transmission. Programmatic focus should include intensified social behavior change communication, targeted directly observed therapy, and evaluation of shorter primaquine or single-dose tafenoquine treatments with G6PD testing to enhance radical cure and accelerate India's 2030 malaria elimination goal.