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Do price subsidies on artemisinin combination therapy for malaria increase household use? Evidence from a repeated cross-sectional study in remote regions of Tanzania.
PLoS One. 2013; 8(7):e70713.Plos

Abstract

BACKGROUND

The Affordable Medicines Facility-malaria (AMFm) is a pilot program that uses price subsidies to increase access to Artemisinin Combination Therapies (ACTs), currently the most effective malaria treatment. Recent evidence suggests that availability and affordability of ACTs in retail sector drug shops (where many people treat malaria) has increased under the AMFm, but it is unclear whether household level ACT use has increased.

METHODS AND FINDINGS

household surveys were conducted in two remote regions of Tanzania (Mtwara and Rukwa) in three waves: March 2011, December 2011 and March 2012, corresponding to 3, 13 and 16 months into the AMFm implementation respectively. Information about suspected malaria episodes including treatment location and medications taken was collected. Respondents were also asked about antimalarial preferences and perceptions about the availability of these medications. Significant increases in ACT use, preference and perceived availability were found between Rounds 1 and 3 though not for all measures between Rounds 1 and 2. ACT use among suspected malaria episodes was 51.1% in March 2011 and increased by 10.9 percentage points by Round 3 (p = .017). The greatest increase was among retail sector patients, where ACT use increased from 31% in Round 1 to 49% in Round 2 (p = .037) and to 61% (p<.0001) by Round 3. The fraction of suspected malaria episodes treated in the retail sector increased from 30.2% in Round 1 to 46.7% in Round 3 (p = .0009), mostly due to a decrease in patients who sought no treatment at all. No significant changes in public sector treatment seeking were found.

CONCLUSIONS

The AMFm has led to significant increases in ACT use for suspected malaria, especially in the retail sector. No evidence is found supporting the concerns that the AMFm would crowd out public sector treatment or neglect patients in remote areas and from low SES groups.

Authors+Show Affiliations

Global Health and Population Department, Harvard School of Public Health, Harvard University, Boston, Massachusetts, United States of America. cohenj@hsph.harvard.eduNo 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
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

23923018

Citation

Cohen, Jessica L., et al. "Do Price Subsidies On Artemisinin Combination Therapy for Malaria Increase Household Use? Evidence From a Repeated Cross-sectional Study in Remote Regions of Tanzania." PloS One, vol. 8, no. 7, 2013, pp. e70713.
Cohen JL, Yadav P, Moucheraud C, et al. Do price subsidies on artemisinin combination therapy for malaria increase household use? Evidence from a repeated cross-sectional study in remote regions of Tanzania. PLoS One. 2013;8(7):e70713.
Cohen, J. L., Yadav, P., Moucheraud, C., Alphs, S., Larson, P. S., Arkedis, J., Massaga, J., & Sabot, O. (2013). Do price subsidies on artemisinin combination therapy for malaria increase household use? Evidence from a repeated cross-sectional study in remote regions of Tanzania. PloS One, 8(7), e70713. https://doi.org/10.1371/journal.pone.0070713
Cohen JL, et al. Do Price Subsidies On Artemisinin Combination Therapy for Malaria Increase Household Use? Evidence From a Repeated Cross-sectional Study in Remote Regions of Tanzania. PLoS One. 2013;8(7):e70713. PubMed PMID: 23923018.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Do price subsidies on artemisinin combination therapy for malaria increase household use? Evidence from a repeated cross-sectional study in remote regions of Tanzania. AU - Cohen,Jessica L, AU - Yadav,Prashant, AU - Moucheraud,Corrina, AU - Alphs,Sarah, AU - Larson,Peter S, AU - Arkedis,Jean, AU - Massaga,Julius, AU - Sabot,Oliver, Y1 - 2013/07/29/ PY - 2012/09/15/received PY - 2013/06/27/accepted PY - 2013/8/8/entrez PY - 2013/8/8/pubmed PY - 2014/8/22/medline SP - e70713 EP - e70713 JF - PloS one JO - PLoS One VL - 8 IS - 7 N2 - BACKGROUND: The Affordable Medicines Facility-malaria (AMFm) is a pilot program that uses price subsidies to increase access to Artemisinin Combination Therapies (ACTs), currently the most effective malaria treatment. Recent evidence suggests that availability and affordability of ACTs in retail sector drug shops (where many people treat malaria) has increased under the AMFm, but it is unclear whether household level ACT use has increased. METHODS AND FINDINGS: household surveys were conducted in two remote regions of Tanzania (Mtwara and Rukwa) in three waves: March 2011, December 2011 and March 2012, corresponding to 3, 13 and 16 months into the AMFm implementation respectively. Information about suspected malaria episodes including treatment location and medications taken was collected. Respondents were also asked about antimalarial preferences and perceptions about the availability of these medications. Significant increases in ACT use, preference and perceived availability were found between Rounds 1 and 3 though not for all measures between Rounds 1 and 2. ACT use among suspected malaria episodes was 51.1% in March 2011 and increased by 10.9 percentage points by Round 3 (p = .017). The greatest increase was among retail sector patients, where ACT use increased from 31% in Round 1 to 49% in Round 2 (p = .037) and to 61% (p<.0001) by Round 3. The fraction of suspected malaria episodes treated in the retail sector increased from 30.2% in Round 1 to 46.7% in Round 3 (p = .0009), mostly due to a decrease in patients who sought no treatment at all. No significant changes in public sector treatment seeking were found. CONCLUSIONS: The AMFm has led to significant increases in ACT use for suspected malaria, especially in the retail sector. No evidence is found supporting the concerns that the AMFm would crowd out public sector treatment or neglect patients in remote areas and from low SES groups. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/23923018/Do_price_subsidies_on_artemisinin_combination_therapy_for_malaria_increase_household_use_Evidence_from_a_repeated_cross_sectional_study_in_remote_regions_of_Tanzania_ L2 - https://dx.plos.org/10.1371/journal.pone.0070713 DB - PRIME DP - Unbound Medicine ER -