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Expanding access to parasite-based malaria diagnosis through retail drug shops in Tanzania: evidence from a randomized trial and implications for treatment.
Malar J. 2017 01 03; 16(1):6.MJ

Abstract

BACKGROUND

Tanzania has seen a reduction in the fraction of fevers caused by malaria, likely due in part to scale-up of control measures. While national guidelines require parasite-based diagnosis prior to treatment, it is estimated that more than half of suspected malaria treatment-seeking in Tanzania initiates in the private retail sector, where diagnosis by malaria rapid diagnostic test (RDT) or microscopy is illegal. This pilot study investigated whether the introduction of RDTs into Accredited Drug Dispensing Outlets (ADDOs) under realistic market conditions would improve case management practices.

METHODS

Dispensers from ADDOs in two intervention districts in Tanzania were trained to stock and perform RDTs and monitored quarterly. Each district was assigned a different recommended retail price to evaluate the need for a subsidy. Malaria RDT and artemisinin-based combination therapy (ACT) uptake and availability were measured pre-intervention and 1 year post-intervention through structured surveys of ADDO owners and exiting customers in both intervention districts and one contiguous control district. Descriptive analysis and logistic regression were used to compare the three districts and identify predictive variables for testing.

RESULTS AND DISCUSSION

A total of 310 dispensers from 262 ADDOs were trained to stock and perform RDTs. RDT availability in intervention ADDOs increased from 1% (n = 172) to 73% (n = 163) during the study; ACT medicines were available in 75% of 260 pre-intervention and 68% of 254 post-intervention ADDOs. Pre-treatment testing performed within the ADDO increased from 0 to 65% of suspected malaria patients who visited a shop (95% CI 60.8-69.6%) with no difference between intervention districts. Overall parasite-based diagnosis increased from 19 to 74% in intervention districts and from 3 to 18% in the control district. Prior knowledge of RDT availability (aOR = 1.9, p = 0.03) and RDT experience (aOR = 1.9, p = 0.01) were predictors for testing. Adherence data indicated that 75% of malaria positives received ACT, while 3% of negatives received ACT.

CONCLUSIONS

Trained and supervised ADDO dispensers in rural Tanzania performed and sold RDTs under real market conditions to two-thirds of suspected malaria patients during this one-year pilot. These results support the hypothesis that introducing RDTs into regulated private retail sector settings can improve malaria testing and treatment practices without an RDT subsidy. Trial registration ISRCTN ISRCTN14115509.

Authors+Show Affiliations

Clinton Health Access Initiative, Inc., 383 Dorchester Avenue Suite 400, Boston, MA, 02127, USA.Clinton Health Access Initiative, Inc., 383 Dorchester Avenue Suite 400, Boston, MA, 02127, USA. award@clintonhealthaccess.org.Clinton Health Access Initiative, Inc., Tanzania Office, Dar es Salaam, Tanzania.Clinton Health Access Initiative, Inc., 383 Dorchester Avenue Suite 400, Boston, MA, 02127, USA.Clinton Health Access Initiative, Inc., 383 Dorchester Avenue Suite 400, Boston, MA, 02127, USA.Clinton Health Access Initiative, Inc., 383 Dorchester Avenue Suite 400, Boston, MA, 02127, USA.Clinton Health Access Initiative, Inc., 383 Dorchester Avenue Suite 400, Boston, MA, 02127, USA.Clinton Health Access Initiative, Inc., 383 Dorchester Avenue Suite 400, Boston, MA, 02127, USA.Clinton Health Access Initiative, Inc., 383 Dorchester Avenue Suite 400, Boston, MA, 02127, USA.Clinton Health Access Initiative, Inc., 383 Dorchester Avenue Suite 400, Boston, MA, 02127, USA.Clinton Health Access Initiative, Inc., Tanzania Office, Dar es Salaam, Tanzania.Tanzania National Malaria Control Programme, Dar es Salaam, Tanzania.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

28049481

Citation

Maloney, Kathleen, et al. "Expanding Access to Parasite-based Malaria Diagnosis Through Retail Drug Shops in Tanzania: Evidence From a Randomized Trial and Implications for Treatment." Malaria Journal, vol. 16, no. 1, 2017, p. 6.
Maloney K, Ward A, Krenz B, et al. Expanding access to parasite-based malaria diagnosis through retail drug shops in Tanzania: evidence from a randomized trial and implications for treatment. Malar J. 2017;16(1):6.
Maloney, K., Ward, A., Krenz, B., Petty, N., Bryson, L., Dolkart, C., Visser, T., Le Menach, A., Scott, V. K., Cohen, J. M., Mtumbuka, E., & Mkude, S. (2017). Expanding access to parasite-based malaria diagnosis through retail drug shops in Tanzania: evidence from a randomized trial and implications for treatment. Malaria Journal, 16(1), 6. https://doi.org/10.1186/s12936-016-1658-y
Maloney K, et al. Expanding Access to Parasite-based Malaria Diagnosis Through Retail Drug Shops in Tanzania: Evidence From a Randomized Trial and Implications for Treatment. Malar J. 2017 01 3;16(1):6. PubMed PMID: 28049481.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Expanding access to parasite-based malaria diagnosis through retail drug shops in Tanzania: evidence from a randomized trial and implications for treatment. AU - Maloney,Kathleen, AU - Ward,Abigail, AU - Krenz,Bonnie, AU - Petty,Nora, AU - Bryson,Lindsay, AU - Dolkart,Caitlin, AU - Visser,Theodoor, AU - Le Menach,Arnaud, AU - Scott,Valerie K, AU - Cohen,Justin M, AU - Mtumbuka,Esther, AU - Mkude,Sigsbert, Y1 - 2017/01/03/ PY - 2016/07/09/received PY - 2016/12/15/accepted PY - 2017/1/5/entrez PY - 2017/1/5/pubmed PY - 2017/6/24/medline KW - Parasite-based malaria diagnosis KW - Private retail sector KW - Rapid diagnostic test KW - Tanzania SP - 6 EP - 6 JF - Malaria journal JO - Malar J VL - 16 IS - 1 N2 - BACKGROUND: Tanzania has seen a reduction in the fraction of fevers caused by malaria, likely due in part to scale-up of control measures. While national guidelines require parasite-based diagnosis prior to treatment, it is estimated that more than half of suspected malaria treatment-seeking in Tanzania initiates in the private retail sector, where diagnosis by malaria rapid diagnostic test (RDT) or microscopy is illegal. This pilot study investigated whether the introduction of RDTs into Accredited Drug Dispensing Outlets (ADDOs) under realistic market conditions would improve case management practices. METHODS: Dispensers from ADDOs in two intervention districts in Tanzania were trained to stock and perform RDTs and monitored quarterly. Each district was assigned a different recommended retail price to evaluate the need for a subsidy. Malaria RDT and artemisinin-based combination therapy (ACT) uptake and availability were measured pre-intervention and 1 year post-intervention through structured surveys of ADDO owners and exiting customers in both intervention districts and one contiguous control district. Descriptive analysis and logistic regression were used to compare the three districts and identify predictive variables for testing. RESULTS AND DISCUSSION: A total of 310 dispensers from 262 ADDOs were trained to stock and perform RDTs. RDT availability in intervention ADDOs increased from 1% (n = 172) to 73% (n = 163) during the study; ACT medicines were available in 75% of 260 pre-intervention and 68% of 254 post-intervention ADDOs. Pre-treatment testing performed within the ADDO increased from 0 to 65% of suspected malaria patients who visited a shop (95% CI 60.8-69.6%) with no difference between intervention districts. Overall parasite-based diagnosis increased from 19 to 74% in intervention districts and from 3 to 18% in the control district. Prior knowledge of RDT availability (aOR = 1.9, p = 0.03) and RDT experience (aOR = 1.9, p = 0.01) were predictors for testing. Adherence data indicated that 75% of malaria positives received ACT, while 3% of negatives received ACT. CONCLUSIONS: Trained and supervised ADDO dispensers in rural Tanzania performed and sold RDTs under real market conditions to two-thirds of suspected malaria patients during this one-year pilot. These results support the hypothesis that introducing RDTs into regulated private retail sector settings can improve malaria testing and treatment practices without an RDT subsidy. Trial registration ISRCTN ISRCTN14115509. SN - 1475-2875 UR - https://www.unboundmedicine.com/medline/citation/28049481/Expanding_access_to_parasite_based_malaria_diagnosis_through_retail_drug_shops_in_Tanzania:_evidence_from_a_randomized_trial_and_implications_for_treatment_ L2 - https://malariajournal.biomedcentral.com/articles/10.1186/s12936-016-1658-y DB - PRIME DP - Unbound Medicine ER -