Correction: Incentivizing appropriate malaria case management in the private sector: a study protocol for two linked cluster randomized controlled trials to evaluate provider- and client-focused interventions in western Kenya and Lagos, Nigeria

Woolsey, Aaron M.; Simmons, Ryan; Woldeghebriel, Meley; Zhou, Yunji; Ogunsola, Oluwatosin; Laing, Sarah; Olaleye, Tayo; Kipkoech, Joseph; Rojas, Bomar Mendez; Saran, Indrani; Odhiambo, Mercy; Malinga, Josephine; Ambani, George; Kimachas, Emmah; Fashanu, Chizoba; Wiwa, Owens; Menya, Diana; Laktabai, Jeremiah; Visser, Theodoor; Turner, Elizabeth L.; O’Meara, Wendy Prudhomme

doi:10.1186/s13012-022-01233-4

Cited by 2 publications

(4 citation statements)

References 3 publications

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“…Forty retail medicine outlets (clusters) were enrolled and randomized to one of three arms: a control arm, a client-directed conditional subsidy arm (CD), and an arm with a combined conditional subsidy plus provider incentive (CDPD) arm. Full details of the study design were previously reported in the study protocol [ 12 ] and accompanying amendment by Woolsey et al [ 13 ] and are summarized here. Results from the TESTsmART study in Nigeria (TESTsmART Nigeria) will be reported separately.…”

Section: Methodsmentioning

confidence: 99%

“…We designed the study to attain a minimum of 80% power at an overall 5% significance level for each of two pre-specified comparisons between arms for the primary outcome: the combined intervention (CDPD) arm vs. the client-directed (CD) arm and the CDPD arm vs. the control arm. All power calculations were based on a formula from Moulton and Hayes for comparing two proportions under a cluster-randomized trial design with details previously published [ 12 , 13 ]. Using the conservative Bonferroni correction for our two pre-specified comparisons and using pre-randomization data on malaria testing and treatment behavior reported in the app, we expected to achieve 80.2% power for our comparison of the CDPD arm vs. the CD arm, and greater than 95% power for our comparison of the CDPD arm vs. the control arm.…”

Section: Methodsmentioning

confidence: 99%

“…Outlets were mapped, surveyed and enrolled as described in Woolsey et al [ 12 , 13 ]. Following enrollment, retail outlets were randomized to arms by the study statistician.…”

Section: Methodsmentioning

confidence: 99%

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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: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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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

Self Cite

View full text Add to dashboard Cite

show abstract

“…The study was designed to attain a minimum of 80% power at an overall 5% significance level for each of two pre-specified comparisons between arms for the primary outcome: the combined intervention (CDPD) arm vs. the client-directed (CD) arm and the CDPD arm vs. the control arm. All power calculations were based on a formula from Moulton and Hayes for comparing two proportions under a cluster-randomized trial design with details previously published 12, 13 . Using the conservative Bonferroni correction for our two pre-specified comparisons and using pre-randomization data on malaria testing and treatment behavior reported in the app, we expected to achieve 80.2% power for our comparison of the CDPD arm vs. the CD arm, and greater than 95% power for our comparison of the CDPD arm vs. the control arm.…”

Section: Methodsmentioning

confidence: 99%

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

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Correction: Incentivizing appropriate malaria case management in the private sector: a study protocol for two linked cluster randomized controlled trials to evaluate provider- and client-focused interventions in western Kenya and Lagos, Nigeria

Cited by 2 publications

References 3 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

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