The intervention leads to better use of malaria Tx

A community intervention to link the distribution of grants for some malaria treatments to a positive diagnostic test for malaria has led to increased adoption of diagnostic tests and the appropriate use of these tests. drugs, the researchers found. participants in the intervention group were more likely to have malaria diagnostic tests for recent fever at 12 months compared to controls (ad Justed RR 1.20, 95% CI 1.05 to 1 , 38, P = 0.015), reported Wendy Prudhomme O. Meara, MD, of Duke University in Durham, North Carolina, and her colleagues.

In addition, the intervention the authors wrote in PLoS Medicine

They noted that while "public subsidies" have reduced the cost of therapeutic combinations based on artemisinin, they led to an increase in the rational use of artemisinins. are still not targeted at those who are actually diagnosed with malaria. Studies estimate that people without malaria consume 66% to 80% of over-the-counter artemisinin-based combination therapies, largely because "Malaria diagnostic tests are absent from the retail sector. ". Additional research has also revealed that 70% of people with malaria, but no information about their diagnosis, are not looking for these therapies.

The authors also stated that such overuse could potentially contribute to resistance, and there is no "discordance between who needs an ACT and who l & rsquo; Buys underscores the importance of improving access to diagnostic tests for those seeking care outside the formal health sector, "he added. they quarreled. "Targeting subsidized ACTs to people with parasitologically confirmed malaria could make a significant contribution to the sustainability and cost-effectiveness of donor-funded grants and preserve the future effectiveness of these key drugs." [19659005] In the intervention groups, community health workers were available in the villages to perform "on-demand" rapid diagnostic tests for anyone with a health and addiction problem. disease similar to malaria. Participants then received a voucher for a discount on therapeutic combinations of artemisinin at a participating retail drug retail outlet.

The control groups received "a set of standard education, prevention and referral services". The surveys were conducted at baseline, 6 months, 12 months, and 18 months.

The main result was the malaria diagnostic test after 12 months, and the main secondary outcome was "ACT efficiency" defined as "the proportion of ACTs used"

in the Together, 7,416 households with fever in the last month participated in the survey, either at baseline, 6 months, 12 months or 20 months. Of these, about 63% of recent fevers were in children under 18 years of age. While the sample included an equal distribution of boys and girls, the sample of adults accounted for about 78% of women.

There were 2,017 participants in the reference sample, about two-thirds of whom received combinations of artemisinin for their disease and about 40% during the 12-month survey, 454 participants in the intervention group (50.5%) had a malaria diagnostic test for their recent fever compared to 389 participants in the control group (43.4%).

The authors noted that a "substantial improvement in the rational use of ACT was observed at the end of the study period". The intervention resulted in a 40% relative increase in the "proportion of ACT doses administered to people with a positive malaria test" (44.1% vs. 51.9%, RR adjusted 1.40, 95% CI). % 1.19 to 1.64, P <0.001).

In addition, they found a relative reduction of 30% in the proportion of ACT administered to those without test (37.3% vs. 51.9%, adjusted RR 0.70, 95% CI 0 , 60 to 0.83). The limitations included the fact that the authors were not able to "separate the effect of the free test from the acceptance of the test", which could only be solved by a similar study with free tests without conditional coupons in the control arm. In addition, the study could not be continued to measure long-term effects, and the results were based on self-evaluation of respondent or participant.

• Reviewed by
  Robert Jasmer, MD Associate Professor of Clinical Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, Nurse, Nurse Planner

2018-07-17T17: 15: 00-0400