Introducing rapid tests for malaria into the retail sector: what are the unintended consequences?
Introducing rapid tests for malaria into the retail sector: what are the unintended consequences?
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DOI：
10.1136/bmjgh-2016-000067
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发表时间：
2017
影响因子：
8.1
通讯作者：
Chandler CIR
中科院分区：
文献类型：
--
作者：
Hutchinson E;Hutchison C;Lal S;Hansen K;Kayendeke M;Nabirye C;Magnussen P;Clarke SE;Mbonye A;Chandler CIR
观察到许多非洲人在零售部门寻求发热性疾病的护理，这导致了一些公共卫生倡议，试图提高在这些环境中提供的护理质量。支持将疟疾快速诊断测试引入药店的可能性正在受到越来越多的审查。赞成者认为，它能够协调有关疟疾检测和治疗的政策，并将重点放在基于市场的医疗保健解决方案上。尽管许多全球卫生行动者对这一政策选择充满热情，但对零售部门引入mRDTs的后果的理解有限。我们对药店供应商（DSV）、其客户和当地卫生工作者进行了一项解释性混合方法研究，以探索mRDT的使用和解释，因为它们在乌干达穆科诺区的试验期间成为药店日常实践的一部分。本文报告了它们的引入带来的意外后果。报告介绍了这种检测如何使人们对家庭诊断和服务志愿者的专业能力产生信任;客户和提供者将其误解为能够对一般疾病而不仅仅是疟疾进行更明确的诊断;血液检测使药店比以前更有吸引力地寻求护理;被描述为将寻求治疗的行为从正规保健中心转移到药店;并影响了药物销售的增长，特别是抗生素。 NCT 01194557;结果。
The observation that many people in Africa seek care for febrile illness in the retail sector has led to a number of public health initiatives to try to improve the quality of care provided in these settings. The potential to support the introduction of rapid diagnostic tests for malaria (mRDTs) into drug shops is coming under increased scrutiny. Those in favour argue that it enables the harmonisation of policy around testing and treatment for malaria and maintains a focus on market-based solutions to healthcare. Despite the enthusiasm among many global health actors for this policy option, there is a limited understanding of the consequences of the introduction of mRDTs in the retail sector. We undertook an interpretive, mixed methods study with drug shop vendors (DSVs), their clients and local health workers to explore the uses and interpretations of mRDTs as they became part of daily practice in drug shops during a trial in Mukono District, Uganda. This paper reports the unintended consequences of their introduction. It describes how the test engendered trust in the professional competence of DSVs; was misconstrued by clients and providers as enabling a more definitive diagnosis of disease in general rather than malaria alone; that blood testing made drug shops more attractive places to seek care than they had previously been; was described as shifting treatment-seeking behaviour away from formal health centres and into drug shops; and influenced an increase in sales of medications, particularly antibiotics. NCT01194557; Results.