Expanding access to parasite-based malaria diagnosis through retail drug shops in Tanzania: evidence from a randomized trial and implications for treatment
Expanding access to parasite-based malaria diagnosis through retail drug shops in Tanzania: evidence from a randomized trial and implications for treatment
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DOI：
10.1186/s12936-016-1658-y
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发表时间：
2017-01-03
期刊：
影响因子：
3
通讯作者：
Mkude, Sigsbert
中科院分区：
文献类型：
--
作者：
Maloney, Kathleen;Ward, Abigail;Mkude, Sigsbert
背景：坦桑尼亚疟疾引起的发热比例有所下降，部分原因可能是扩大了控制措施。虽然国家准则要求在治疗前进行寄生虫诊断，但据估计，坦桑尼亚一半以上的疑似疟疾寻求治疗是在私营零售部门开始的，在那里，疟疾快速诊断测试或显微镜检查诊断是非法的。这项试点研究调查是否引入RDTs到认可的药物分配网点（ADDOs）在现实的市场条件下，将提高病例管理practices.Methods：配药ADDOs在坦桑尼亚的两个干预区进行培训，股票和执行RDTs和监测季度。每个地区都被分配了一个不同的建议零售价格，以评估是否需要补贴。疟疾RDT和青蒿素为基础的组合疗法（ACT）的吸收和可用性进行了测量干预前和干预后1年，通过结构化调查ADDO业主和退出客户在两个干预区和一个连续的控制区。描述性分析和Logistic回归被用来比较这三个地区，并确定预测变量testing.Results和讨论：共310配药从262 ADDO进行了培训，股票和执行RDTs。在研究期间，干预ADDO中的RDT可用性从1%（n = 172）增加到73%（n = 163）; ACT药物在260个干预前ADDO中的75%和254个干预后ADDO中的68%中可用。在ADDO内进行的治疗前检测从0增加到65%的疑似疟疾患者谁访问了商店（95%CI 60.8-69.6%），干预区之间没有差异。在干预区，基于寄生虫的总体诊断从19%增加到74%，在对照区从3%增加到18%。RDT可用性的先前知识（aOR = 1.9，p = 0.03）和RDT经验（aOR = 1.9，p = 0.01）是测试的预测因素。依从性数据表明，75%的疟疾阳性收到ACT，而3%的阴性收到ACT.Conclusions：培训和监督ADDO配药坦桑尼亚农村进行和销售RDTs在真实的市场条件下，三分之二的疑似疟疾患者在这一年的试点。这些结果支持了这一假设，即在受监管的私营零售部门环境中引入RDT可以在没有RDT补贴的情况下改善疟疾检测和治疗实践。
Background: Tanzania has seen a reduction in the fraction of fevers caused by malaria, likely due in part to scale-up of control measures. While national guidelines require parasite-based diagnosis prior to treatment, it is estimated that more than half of suspected malaria treatment-seeking in Tanzania initiates in the private retail sector, where diagnosis by malaria rapid diagnostic test (RDT) or microscopy is illegal. This pilot study investigated whether the introduction of RDTs into Accredited Drug Dispensing Outlets (ADDOs) under realistic market conditions would improve case management practices.Methods: Dispensers from ADDOs in two intervention districts in Tanzania were trained to stock and perform RDTs and monitored quarterly. Each district was assigned a different recommended retail price to evaluate the need for a subsidy. Malaria RDT and artemisinin-based combination therapy (ACT) uptake and availability were measured pre-intervention and 1 year post-intervention through structured surveys of ADDO owners and exiting customers in both intervention districts and one contiguous control district. Descriptive analysis and logistic regression were used to compare the three districts and identify predictive variables for testing.Results and discussion: A total of 310 dispensers from 262 ADDOs were trained to stock and perform RDTs. RDT availability in intervention ADDOs increased from 1% (n = 172) to 73% (n = 163) during the study; ACT medicines were available in 75% of 260 pre-intervention and 68% of 254 post-intervention ADDOs. Pre-treatment testing performed within the ADDO increased from 0 to 65% of suspected malaria patients who visited a shop (95% CI 60.8-69.6%) with no difference between intervention districts. Overall parasite-based diagnosis increased from 19 to 74% in intervention districts and from 3 to 18% in the control district. Prior knowledge of RDT availability (aOR = 1.9, p = 0.03) and RDT experience (aOR = 1.9, p = 0.01) were predictors for testing. Adherence data indicated that 75% of malaria positives received ACT, while 3% of negatives received ACT.Conclusions: Trained and supervised ADDO dispensers in rural Tanzania performed and sold RDTs under real market conditions to two-thirds of suspected malaria patients during this one-year pilot. These results support the hypothesis that introducing RDTs into regulated private retail sector settings can improve malaria testing and treatment practices without an RDT subsidy.