The private sector market for malaria rapid diagnostic tests in Nigeria: results of the 2018 market survey

Abstract

Background To avoid misuse of anti-malarials, correct diagnosis of fever prior to drug prescription is essential. Presumptive treatment in the private healthcare sector is a concern in Nigeria, where availability of affordable artemisinin-based combination therapy (ACT) is high following the implementation of subsidy schemes from 2010 to 2017. Similar subsidies have not, however, been implemented for malaria rapid diagnostic tests (RDTs). A market survey in 2018 predominantly designed to assess the ACT market in the private sector also collected data related to RDTs, results of which are presented herein. Methods A 2018 market survey consisted of (i) an outlet survey targeting private pharmacies and Proprietary and Patent Medicine Vendors (PPMVs) across different regions of Nigeria to assess supply-side market factors related to availability of RDTs (defined as having stock available for purchase at the time of the survey) and (ii) a household survey to determine demand-side factors related to knowledge of RDTs, healthcare-seeking practices and affordability. Results Availability of RDTs at the time of the survey was low in both outlet types and significantly lower in PPMVs (22.1%, 95% CI) among pharmacies versus (13.6%, 95% CI) among PPMVs (p < 0.01). Reasons for not restocking RDTs included low demand and no supply. The majority of households diagnose malaria based on experience, while one-third would visit a PPMV or pharmacy. Half of households had heard of RDTs (48.4%) and 38.6% thought they were affordable. Conclusions Low availability of RDTs among PPMVs and pharmacies may be attributed to lack of demand, supply-side issues and cost. Increasing household knowledge of RDTs may aid increasing demand, while subsidized RDTs may address supply and price issues. Addressing the deficit in RDT provision is important for targeting of ACT medicines.

Stakeholders’ perception of a total market approach to HIV self-testing (HIVST) for the private sector in Nigeria

“…Other challenges or barriers faced across the supply chain for HIVST in this study stemmed from low demand for point of care delivery from the manufacturers such as difficulty in reading instructional materials (e.g., leaflets and inserts), promotional materials (banners, roll-up items and stickers), and storage conditions (kits requiring special temperature and capacity development for HIVST. This is similar to challenges faced in African countries with implementing rapid diagnostic tests such as malaria in the private sector [ 21 – 23 ]. Therefore, there is a need to better support the needed paradigm shift, an upward policy development that should accommodate local language development for instructional and promotional items, logistical and capacity development to support for demand creation that will promote local buy-in and can inform behavioral change communication strategies targeting providers.…”

Improving malaria case management with artemisinin-based combination therapies and malaria rapid diagnostic tests in private medicine retail outlets in sub-Saharan Africa: a systematic review

“…However, evidence on the growing predominance of non quality-assured ACTs (i.e. not meeting international quality requirements) in retail markets in recent years [77][78][79], indicates that subsidies could still play a role in increasing the market share of quality-assured medicines. However, this may face resistance from those who fear this would crowd-out local manufacturers who lack the capacity to apply for pre-qualified status [18].…”

A cluster-randomized trial of client and provider directed financial interventions to align incentives with appropriate case management in private medicine retailers: results of the TESTsmART Trial in Lagos, Nigeria

“…Compliance with national malaria treatment guidelines is generally considered poor in these outlets [4,5,6]. Few clients receive a confirmatory malaria diagnosis prior to treatment, with PMRs and their clients often forgoing the test or taking antimalarials even when the test result is negative [7].…”