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Free malaria tests coupled with diagnosis-dependent vouchers for over-the-counter malaria treatment

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Credit: President's Malaria Initiative, Flickr

Coupling free diagnostic tests for malaria with discounts on artemisinin combination therapy (ACT) when malaria is diagnosed can improve the rational use of ACTs and boost testing rates, according to a cluster-randomized trial published this week in PLOS Medicine by Wendy Prudhomme O'Meara of Duke University, USA, and colleagues.

More than half of all ACTs consumed globally are dispensed over the counter in the retail sector, where diagnostic testing is uncommon, leading to overconsumption and misuse of antimalarial drugs. In the new study, the researchers randomly assigned 32 communities in Western Kenya, with a combined population of 160,000, to control or intervention arms. Intervention arms had community health workers offering free malaria tests for any individual experiencing malaria-like symptoms. Those who tested positive for malaria received a discount voucher for ACT. In control areas, community health workers continued to provide health promotion and referral services according to government guidelines.

Among all areas, between July 2015 and May 2017, 32,404 people were tested for malaria and 10,870 vouchers were issued for discounted ACTs. A total of 7,416 randomly selected participants with recent fever were surveyed. After 12 months, 50.5% of people surveyed in intervention areas, with recent fever, had taken a malaria diagnostic test, while only 43.4% of those with recent fever in control areas had taken a test (adjusted risk ratio 1.20; 95% confidence interval 1.05-1.38, p=0.015). Moreover, the rational use of ACTs-- the proportion of ACT used by those testing positive for malaria--increased from 41.7% at baseline to 59.6% at 18 months in intervention areas, and the proportion of ACT dispensed to true malaria cases in the intervention arm was 40% higher than in the control arm (adjusted risk ratio 1.40; 95% CI 1.19-1.64, p<0.001).

"Community-based interventions that include the private sector can have an important impact on diagnostic testing and population-wide rational use of ACTs, as well as potentially improve care for the millions of suspected malaria cases seeking treatment in retail outlets," the authors say.

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Research Article

Funding:

This study received funding from Award Number R01AI110478 from the National Institute of Allergy and Infectious Diseases of the National Institutes of Health (US). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

The authors have declared that no competing interests exist.

Citation:

Prudhomme O'Meara W, Menya D, Laktabai J, Platt A, Saran I, Maffioli E, et al. (2018) Improving rational use of ACTs through diagnosis-dependent subsidies: Evidence from a cluster-randomized controlled trial in western Kenya. PLoS Med 15(7): e1002607. https://doi.org/10.1371/journal.pmed.1002607

Image Credit: President's Malaria Initiative, Flickr

Author Affiliations:

Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya
Moi University School of Medicine, College of Health Sciences, Eldoret, Kenya
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, United States of America
Department of Economics, Duke University, Durham, North Carolina, United States of America
Sanford School of Public Policy, Duke University, Durham, North Carolina, United States of America

In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002607

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