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IMAGE: Free malaria tests.
Coupling free malaria diagnostic tests with discounts on artemisinin combination therapy (ACT) when malaria is diagnosed can improve the rational use of ACTs and increase screening rates, according to a cluster randomized trial published this week in PLOS Medicine by Wendy Prudhomme O. Meara of Duke University, USA, and colleagues.
More than half of all ACTs around the world are dispensed without a prescription in the retail sector, where diagnostic testing is scarce, resulting in overuse and misuse of antimalarial drugs. In the new study, researchers randomly badigned 32 communities in western Kenya, with a total population of 160,000, to control or intervention arms. The intervention teams had community health workers offering free malaria tests for anyone with symptoms similar to those of malaria. Those who tested positive for malaria received a coupon for ACT. In the control areas, community health workers continued to provide health promotion and referral services in accordance with government guidelines.
Of all the regions, between July 2015 and May 2017, 32,404 people were tested for malaria and 10,870 were issued for ACTs at reduced prices. A total of 7,416 randomly selected participants with recent fever were interviewed. After 12 months, 50.5% of respondents in the intervention areas, with a recent fever, had been tested for malaria, while only 43.4% of newly infected people had been tested ( adjusted risk ratio 1.20, 1.05-1.38, p = 0.015). In addition, the rational use of ACTs – the proportion of ACTs used by HIV-positive people for malaria – increased from 41.7% initially to 59.6% at 18 months in areas with HIV. 39, intervention, and the proportion of ACT distributed the intervention arm was 40% higher than in the control arm (adjusted risk ratio 1.40, 95% CI 1.19-1.64 , p
"Community-based interventions that include the private sector can have a significant impact on diagnostic testing and the rational use of ACTs at the population level, and potentially improve care for the millions of cases of suspected malaria in outlets "the authors say.
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Research Paper
Funding:
This study received funding from Award No. R01AI110478 of the National Institute of Allergy and Infectious Diseases National Institutes of Health (United States). Donors have not played any role in the design of the study, the collection and badysis of data, the decision to publish or the preparation of the manuscript.
Competing interests:
The authors stated that there was no competing interest
] Prudhomme O 'Meara W, Menya D, J Laktabai, Platt A, Saran I , Maffioli E, et al. (2018) Improving the rational use of ACTs through diagnostic-dependent subsidies: results from a cluster randomized controlled trial in western Kenya. PLoS Med 15 (7): e1002607. https: /
Image credit: President's Initiative Against Malaria, Flickr
Affiliations
Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
School of Public Health of Moi University, College of Health Sciences, Eldoret, Kenya
School of Medicine of Moi University, College of Health Sciences, Eldoret, Kenya
Academic Model of Access to Health Care (AMPATH), Eldoret, Kenya
Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, United States of America
Department of Economics, Duke University, Durham, North Carolina, United States of America
Sanford School of Public Policy, Duke University, Durham, North Carolina, United States of America
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