Do Price Subsidies on Artemisinin Combination Therapy for Malaria Increase Household Use?: Evidence from a Repeated Cross-Sectional Study in Remote Regions of Tanzania

Abstract

BackgroundThe Affordable Medicines Facility-malaria (AMFm) is a pilot program that uses price subsidies to increase access to Artemisinin Combination Therapies (ACTs), currently the most effective malaria treatment. Recent evidence suggests that availability and affordability of ACTs in retail sector drug shops (where many people treat malaria) has increased under the AMFm, but it is unclear whether household level ACT use has increased.Methods and FindingsHousehold surveys were conducted in two remote regions of Tanzania (Mtwara and Rukwa) in three waves: March 2011, December 2011 and March 2012, corresponding to 3, 13 and 16 months into the AMFm implementation respectively. Information about suspected malaria episodes including treatment location and medications taken was collected. Respondents were also asked about antimalarial preferences and perceptions about the availability of these medications. Significant increases in ACT use, preference and perceived availability were found between Rounds 1 and 3 though not for all measures between Rounds 1 and 2. ACT use among suspected malaria episodes was 51.1% in March 2011 and increased by 10.9 percentage points by Round 3 (p = .017). The greatest increase was among retail sector patients, where ACT use increased from 31% in Round 1 to 49% in Round 2 (p = .037) and to 61% (p<.0001) by Round 3. The fraction of suspected malaria episodes treated in the retail sector increased from 30.2% in Round 1 to 46.7% in Round 3 (p = .0009), mostly due to a decrease in patients who sought no treatment at all. No significant changes in public sector treatment seeking were found.ConclusionsThe AMFm has led to significant increases in ACT use for suspected malaria, especially in the retail sector. No evidence is found supporting the concerns that the AMFm would crowd out public sector treatment or neglect patients in remote areas and from low SES groups.

Challenges in Treatment for Fever among School-Age Children and Adults in Malawi

“…Several trials across Africa have found that subsidies on RDTs and ACTs substantially increase their purchase and appropriate use for antimalaria treatment in retail shops. [35][36][37][38][39][40] If age-related differences are more attributable to perceptions of malaria risks, informational campaigns would be needed to encourage the use of recommended care. This study did not disentangle the reasons for different treatment-seeking choices.…”

Changes in the availability and affordability of subsidised artemisinin combination therapy in the private drug retail sector in rural Ghana: before and after the introduction of the AMFm subsidy

“…It is not able directly to examine the final one, to increase ACT use, and there is evidence that in some settings increasing availability of affordable ACTs in the private sector does not in itself necessarily increase use, although in others it has been found to. 21,22 …”

Are Tanzanian patients attending public facilities or private retailers more likely to adhere to artemisinin-based combination therapy?

“…ADDOs are allowed to sell a limited number of prescription-only drugs, including an approved list of antibiotics and anti-malarial drugs. Availability of ACT was limited in ADDOs until the implementation of the Affordable Medicines Facility- malaria (AMFm) in 2010, which led to a significant reduction in price and a corresponding increase in availability [ 23 , 27 ].…”