Availability of malaria diagnostic tests, anti-malarial drugs, and the correctness of treatment: a systematic review and meta-analysis

Azizi, Hosein; Esmaeili, Elham Davtalab; Abbasi, Fariba

doi:10.1186/s12936-023-04555-w

Cited by 11 publications

(3 citation statements)

References 41 publications

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“…Information from the mRDT improved targeting of ACTs, particularly reducing consumption among those with a negative test. The adherence to test results observed in our study is comparable to studies from the formal health sector [ 34 ] adding to the evidence that case management is not compromised in retail venues compared to formal health facilities. We observed in our study that a quarter of clients who tested positive at the outlet did not receive an ACT (27%).…”

Section: Discussionsupporting

confidence: 84%

A cluster-randomized trial of client and provider-directed financial interventions to align incentives with appropriate case management in retail medicine outlets: Results of the TESTsmART Trial in western Kenya

Laktabai,

Kimachas,

Kipkoech

et al. 2024

PLOS Glob Public Health

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ACTs are responsible for a substantial proportion of the global reduction in malaria mortality over the last ten years, made possible by publicly-funded subsidies making these drugs accessible and affordable in the private sector. However, inexpensive ACTs available in retail outlets have contributed substantially to overconsumption. We test an innovative, scalable strategy to target ACT-subsidies to clients with a confirmatory diagnosis. We supported malaria testing(mRDTs) in 39 medicine outlets in western Kenya, randomized to three study arms; control arm offering subsidized mRDT testing (0.4USD), client-directed intervention where all clients who received a positive RDT at the outlet were eligible for a free (fully-subsidized) ACT, and a combined client and provider directed intervention where clients with a positive RDT were eligible for free ACT and outlets received 0.1USD for every RDT performed. Our primary outcome was the proportion of ACT dispensed to individuals with a positive diagnostic test. Secondary outcomes included proportion of clients tested at the outlet and adherence to diagnostic test results. 43% of clients chose to test at the outlet. Test results informed treatment decisions, resulting in targeting of ACTs to confirmed malaria cases– 25.3% of test-negative clients purchased an ACT compared to 75% of untested clients. Client-directed and client+provider-directed interventions did not offer further improvements, compared to the control arm, in testing rates(RD = 0.09, 95%CI:-0.08,0.26) or dispensing of ACTs to test-positive clients(RD = 0.01,95% CI:-0.14, 0.16). Clients were often unaware of the price they paid for the ACT leading to uncertainty in whether the ACT subsidy was passed on to the client. This uncertainty undermines our ability to definitively conclude that client-directed subsidies are not effective for improving testing and appropriate treatment. We conclude that mRDTs could reduce ACT overconsumption in the private retail sector, but incentive structures are difficult to scale and their value to private providers is uncertain. Trial registration: ClinicalTrials.gov NCT04428307.

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Section: Discussionsupporting

confidence: 84%

A cluster-randomized trial of client and provider-directed financial interventions to align incentives with appropriate case management in retail medicine outlets: Results of the TESTsmART Trial in western Kenya

Laktabai,

Kimachas,

Kipkoech

et al. 2024

PLOS Glob Public Health

View full text Add to dashboard Cite

show abstract

“…16 Information from the mRDT improved targeting of ACTs, particularly reducing consumption among those with a negative test. The adherence to test results observed in our study is comparable to studies from the formal health sector 33 adding to the evidence that case management is not compromised in retail venues compared to formal health facilities. We observed in our study that a quarter of clients who tested positive at the outlet did not receive an ACT (27%).…”

Section: Discussionsupporting

confidence: 83%

A cluster-randomized trial of client and provider-directed financial interventions to align incentives with appropriate case management in retail medicine outlets: results of the TESTsmART Trial in western Kenya

Laktabai,

Kimachas,

Kipkoech

et al. 2023

Preprint

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ACTs are responsible for a substantial proportion of the global reduction in malaria mortality over the last ten years. These reductions would not have been possible without publicly-funded subsidies making these drugs accessible and affordable in the private sector. However, inexpensive ACTs available in retail outlets have contributed substantially to their overconsumption. We test an innovative, scalable, and sustainable strategy to target ACT subsidies to clients with a confirmatory diagnosis. We supported point-of-care malaria testing (mRDTs) in 39 retail medicine outlets in western Kenya and randomized them to three study arms; control arm offering subsidized RDT testing for 0.4USD, client-directed intervention where all clients who received a positive RDT at the outlet were eligible for a free (fully subsidized) first-line ACT, and a combined client and provider directed intervention where clients with a positive RDT were eligible for free ACT and outlets received 0.1USD for every RDT performed. Our primary outcome was the proportion of ACT dispensed to individuals with a positive diagnostic test. Secondary outcomes included proportion of clients tested at the outlet and adherence to diagnostic test results. 43% of clients chose to test at the outlet. Test results informed treatment decisions and resulted in targeting of ACTs to confirmed malaria cases – 25.3% of test-negative clients purchased an ACT compared to 75% of untested clients. Client-directed and client+provider-directed interventions did not offer further improvements, compared to the control arm, in testing rates (RD=0.09, 95%CI:-0.08,0.26) or dispensing of ACTs to test-positive clients (RD=0.01,95% CI:-0.14, 0.16). Clients were often unaware of the price they paid for the ACT leading to uncertainty in whether the ACT subsidy was passed on to the client. We conclude that mRDTs could reduce ACT overconsumption in the private retail sector, but incentive structures are difficult to scale and their value to private providers is uncertain.

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“…Studies in several sub-Saharan African countries have shown that private health facilities and drug outlet providers lack knowledge and do not adhere to national malaria case management guidelines [7][8][9][10][11][12]. This was con rmed by recent meta-analyses that reported healthcare provider reliance on clinical malaria diagnosis and low adherence to appropriate malaria case management guidelines [13][14][15]. In Kenya, gaps in knowledge have been reported, with drug outlet providers, in particular, showing a poor understanding of national malaria treatment guidelines and a lack of training in malaria case management [16,17].…”

mentioning

confidence: 99%

Healthcare provider and drug dispenser knowledge and adherence to guidelines for the case management of malaria in pregnancy in the context of multiple first-line artemisinin-based combination therapies in Western Kenya

Osoro

Dellicour

Ochodo

et al. 2023

Preprint

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Background Concerns about emerging resistance to artemether-lumefantrine (AL) in Africa prompted the pilot introduction of multiple first-line therapies (MFT) in Western Kenya, potentially exposing women-of-childbearing-age (WOCBA) to antimalarials with unknown safety profiles in the first trimester. We assessed healthcare provider knowledge and adherence to national guidelines for managing malaria in pregnancy in the context of the MFT pilot. Methods From March to April 2022, we conducted a cross-sectional study in 50 health facilities (HF) and 40 drug outlets (DO) using structured questionnaires to assess pregnancy detection, malaria diagnosis, and treatment choices by trimester. Differences between HF and DO providers and between MFT and non-MFT HFs were assessed using Chi-square tests. Results Of 174 providers (77% HF, 23% DO), 56% were from MFT pilot facilities. Most providers had tertiary education; 5% HF and 20% DO had only primary or secondary education. More HF than DO providers had knowledge of malaria treatment guidelines (62% vs 40%, p=0.023), received training in malaria in pregnancy (49% vs 20%, p=0.002), and reported assessing for pregnancy in WOCBA (98% vs 78%, p<0.001). Most providers insisted on parasitological diagnosis, with 59% HF using microscopy and 85% DO using rapid diagnostic tests. More HF than DO providers could correctly name the drugs for treating uncomplicated malaria in the first trimester (oral quinine, or AL if quinine is unavailable) (90% vs 58%, p<0.001), second and third trimesters (artemisinin-based combination therapies) (84% vs 70%, p=0.07), and for severe malaria (parenteral artesunate/artemether) (94% vs 60%, p<0.001). Among HF providers, those in the MFT pilot had more knowledge of malaria treatment guidelines (67% vs 49%, p=0.08) and had received training on treatment of malaria in pregnancy (56% vs 32%, p=0.03). Few providers (10% HF and 12% DO) had adequate knowledge of malaria treatment in pregnancy, defined as the correct drug and dose for uncomplicated and severe malaria in all trimesters. Conclusions Knowledge of national malaria in pregnancy treatment guidelines among providers in western Kenya is suboptimal. Robust training on appropriate antimalarial and dosage is needed. Supervision of DO and HF practices is essential for correct treatment of malaria in pregnancy in the context of MFT programmes.

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Availability of malaria diagnostic tests, anti-malarial drugs, and the correctness of treatment: a systematic review and meta-analysis

Cited by 11 publications

References 41 publications

A cluster-randomized trial of client and provider-directed financial interventions to align incentives with appropriate case management in retail medicine outlets: Results of the TESTsmART Trial in western Kenya

A cluster-randomized trial of client and provider-directed financial interventions to align incentives with appropriate case management in retail medicine outlets: Results of the TESTsmART Trial in western Kenya

A cluster-randomized trial of client and provider-directed financial interventions to align incentives with appropriate case management in retail medicine outlets: results of the TESTsmART Trial in western Kenya

Healthcare provider and drug dispenser knowledge and adherence to guidelines for the case management of malaria in pregnancy in the context of multiple first-line artemisinin-based combination therapies in Western Kenya

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