Socially-marketed rapid diagnostic tests and ACT in the private sector: ten years of experience in Cambodia
Socially-marketed rapid diagnostic tests and ACT in the private sector: ten years of experience in Cambodia
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DOI：
10.1186/1475-2875-10-243
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发表时间：
2011-08-18
期刊：
影响因子：
3
通讯作者：
Socheat, Duong
中科院分区：
文献类型：
--
作者：
Yeung, Shunmay;Patouillard, Edith;Socheat, Duong
虽然一些人口的疟疾发病率最近大幅下降，但大多数最易感染恶性疟原虫疟疾的人仍然无法获得青蒿素综合疗法的有效治疗，其他人已经面临对青蒿素产生抗药性的寄生虫，在这方面，迫切需要通过提供更多高质量的青蒿素综合疗法和寄生虫学诊断，改善青蒿素综合疗法的获得和针对性。这是一个日益紧迫的问题，特别是在私营商业部门，因为在许多国家，私营商业部门在提供疟疾治疗方面发挥着重要作用。负担得起的疟疾药品融资机制是最近的一项举措，旨在通过政府一级的补贴，在公共、私营和非政府组织部门增加负担得起的青蒿素综合疗法的供应。然而，迄今为止，在私营部门有计划地实施有补贴的青蒿素综合疗法方面，几乎没有记录在案的经验。柬埔寨具有独特的地位，不仅在实施有补贴的青蒿素综合疗法方面，而且在实施作为全国社会营销方案一部分的快速诊断测试方面，都有10多年的经验。该方案包括行为改变宣传和私人提供者培训，以及销售和分发推荐的青蒿素综合疗法Malarine和区域发展小组Malacheck。本文描述和评估这方面的经验，借鉴家庭和供应商的调查结果进行了自该方案的start.The现有的证据表明，供应商和消费者的认识，马拉林迅速增加，但Malacheck的少得多。此外，在ACT和RDT的提供和采用方面的改进相对缓慢，特别是在较偏远的地区，调查方法缺乏标准化和数据空白突出表明，必须建立一个明确的系统，对类似举措进行监测和评价。尽管存在这些限制，但仍可以吸取一些重要的教训。其中包括必须制定一项全面的宣传战略和持续可靠地供应产品，同时注意两者的地理范围。其他重要挑战涉及难以激励供应商和消费者不仅选择推荐的药物，而且在此之前进行确证性血液检测，并确保供应商遵守检测结果，患者遵守治疗方案。在柬埔寨，由于药物本身固有的问题和青蒿素耐药性的出现，这一问题特别复杂。
Whilst some populations have recently experienced dramatic declines in malaria, the majority of those most at risk of Plasmodium falciparum malaria still lack access to effective treatment with artemisinin combination therapy (ACT) and others are already facing parasites resistant to artemisinins.In this context, there is a crucial need to improve both access to and targeting of ACT through greater availability of good quality ACT and parasitological diagnosis. This is an issue of increasing urgency notably in the private commercial sector, which, in many countries, plays an important role in the provision of malaria treatment. The Affordable Medicines Facility for malaria (AMFm) is a recent initiative that aims to increase the provision of affordable ACT in public, private and NGO sectors through a manufacturer-level subsidy. However, to date, there is little documented experience in the programmatic implementation of subsidized ACT in the private sector. Cambodia is in the unique position of having more than 10 years of experience not only in implementing subsidized ACT, but also rapid diagnostic tests (RDT) as part of a nationwide social marketing programme. The programme includes behaviour change communication and the training of private providers as well as the sale and distribution of Malarine, the recommended ACT, and Malacheck, the RDT. This paper describes and evaluates this experience by drawing on the results of household and provider surveys conducted since the start of the programme.The available evidence suggests that providers' and consumers' awareness of Malarine increased rapidly, but that of Malacheck much less so. In addition, improvements in ACT and RDT availability and uptake were relatively slow, particularly in more remote areas.The lack of standardization in the survey methods and the gaps in the data highlight the importance of establishing a clear system for monitoring and evaluation for similar initiatives. Despite these limitations, a number of important lessons can still be learnt. These include the importance of a comprehensive communications strategy and of a sustained and reliable supply of products, with attention to the geographical reach of both. Other important challenges relate to the difficulty in incentivising providers and consumers not only to choose the recommended drug, but to precede this with a confirmatory blood test and ensure that providers adhere to the test results and patients to the treatment regime. In Cambodia, this is particularly complicated due to problems inherent to the drug itself and the emergence of artemisinin resistance.