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Piloting the global subsidy: the impact of subsidized artemisinin-based combination therapies distributed through private drug shops in rural Tanzania.
PLoS One. 2009 Sep 02; 4(9):e6857.Plos

Abstract

BACKGROUND

WHO estimates that only 3% of fever patients use recommended artemisinin-based combination therapies (ACTs), partly reflecting their high prices in the retail sector from where many patients seek treatment. To overcome this challenge, a global ACT subsidy has been proposed. We tested this proposal through a pilot program in rural Tanzania.

METHODS/PRINCIPAL FINDINGS

Three districts were assigned to serve either as a control or to receive the subsidy plus a package of supporting interventions. From October 2007, ACTs were sold at a 90% subsidy through the normal private supply chain to intervention district drug shops. Data were collected at baseline and during intervention using interviews with drug shop customers, retail audits, mystery shoppers, and audits of public and NGO facilities. The proportion of consumers in the intervention districts purchasing ACTs rose from 1% at baseline to 44.2% one year later (p<0.001), and was significantly higher among consumers purchasing for children under 5 than for adults (p = 0.005). No change in ACT usage was observed in the control district. Consumers paid a mean price of $0.58 for ACTs, which did not differ significantly from the price paid for sulphadoxine-pyrimethamine, the most common alternative. Drug shops in population centers were significantly more likely to stock ACTs than those in more remote areas (p<0.001).

CONCLUSIONS

A subsidy introduced at the top of the private sector supply chain can significantly increase usage of ACTs and reduce their retail price to the level of common monotherapies. Additional interventions may be needed to ensure access to ACTs in remote areas and for poorer individuals who appear to seek treatment at drug shops less frequently.

TRIAL REGISTRATION

Controlled-Trials.com ISRCTN39125414.

Authors+Show Affiliations

Malaria Control Team, Clinton Foundation HIV/AIDS Initiative, Boston, Massachusetts, USA. osabot@clintonfoundation.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19724644

Citation

Sabot, Oliver J., et al. "Piloting the Global Subsidy: the Impact of Subsidized Artemisinin-based Combination Therapies Distributed Through Private Drug Shops in Rural Tanzania." PloS One, vol. 4, no. 9, 2009, pp. e6857.
Sabot OJ, Mwita A, Cohen JM, et al. Piloting the global subsidy: the impact of subsidized artemisinin-based combination therapies distributed through private drug shops in rural Tanzania. PLoS One. 2009;4(9):e6857.
Sabot, O. J., Mwita, A., Cohen, J. M., Ipuge, Y., Gordon, M., Bishop, D., Odhiambo, M., Ward, L., & Goodman, C. (2009). Piloting the global subsidy: the impact of subsidized artemisinin-based combination therapies distributed through private drug shops in rural Tanzania. PloS One, 4(9), e6857. https://doi.org/10.1371/journal.pone.0006857
Sabot OJ, et al. Piloting the Global Subsidy: the Impact of Subsidized Artemisinin-based Combination Therapies Distributed Through Private Drug Shops in Rural Tanzania. PLoS One. 2009 Sep 2;4(9):e6857. PubMed PMID: 19724644.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Piloting the global subsidy: the impact of subsidized artemisinin-based combination therapies distributed through private drug shops in rural Tanzania. AU - Sabot,Oliver J, AU - Mwita,Alex, AU - Cohen,Justin M, AU - Ipuge,Yahya, AU - Gordon,Megumi, AU - Bishop,David, AU - Odhiambo,Moses, AU - Ward,Lorrayne, AU - Goodman,Catherine, Y1 - 2009/09/02/ PY - 2009/05/02/received PY - 2009/07/21/accepted PY - 2009/9/3/entrez PY - 2009/9/3/pubmed PY - 2010/2/2/medline SP - e6857 EP - e6857 JF - PloS one JO - PLoS One VL - 4 IS - 9 N2 - BACKGROUND: WHO estimates that only 3% of fever patients use recommended artemisinin-based combination therapies (ACTs), partly reflecting their high prices in the retail sector from where many patients seek treatment. To overcome this challenge, a global ACT subsidy has been proposed. We tested this proposal through a pilot program in rural Tanzania. METHODS/PRINCIPAL FINDINGS: Three districts were assigned to serve either as a control or to receive the subsidy plus a package of supporting interventions. From October 2007, ACTs were sold at a 90% subsidy through the normal private supply chain to intervention district drug shops. Data were collected at baseline and during intervention using interviews with drug shop customers, retail audits, mystery shoppers, and audits of public and NGO facilities. The proportion of consumers in the intervention districts purchasing ACTs rose from 1% at baseline to 44.2% one year later (p<0.001), and was significantly higher among consumers purchasing for children under 5 than for adults (p = 0.005). No change in ACT usage was observed in the control district. Consumers paid a mean price of $0.58 for ACTs, which did not differ significantly from the price paid for sulphadoxine-pyrimethamine, the most common alternative. Drug shops in population centers were significantly more likely to stock ACTs than those in more remote areas (p<0.001). CONCLUSIONS: A subsidy introduced at the top of the private sector supply chain can significantly increase usage of ACTs and reduce their retail price to the level of common monotherapies. Additional interventions may be needed to ensure access to ACTs in remote areas and for poorer individuals who appear to seek treatment at drug shops less frequently. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN39125414. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/19724644/Piloting_the_global_subsidy:_the_impact_of_subsidized_artemisinin_based_combination_therapies_distributed_through_private_drug_shops_in_rural_Tanzania_ L2 - https://dx.plos.org/10.1371/journal.pone.0006857 DB - PRIME DP - Unbound Medicine ER -