Malaria diagnostic testing and conditional subsidies to target ACTs in the retail sector: the TESTsmART trial

疟疾诊断测试和针对零售业目标 ACT 的有条件补贴：TESTsmART 试验

• 批准号: 10001444
• 负责人: Wendy PrudhommeOMeara
• 金额: $ 89.45万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-14 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10001444
• 关键词: Adopted; Affect; Africa South of the Sahara; Antimalarials; Artemisinins; Behavior; Budgets; Caring; Case Management; Client; Combined Modality Therapy; Consumption; Country; Diagnosis; Diagnostic tests; Drug resistance; Economically Deprived Population; Ensure; Family; Fever; Funding; Future; Goals; Government; Health; Health Resources; Incentives; Individual; Kenya; Lead; Life; Link; Malaria; Medicine; Nigeria; Outcome; Parasite resistance; Patients; Pharmaceutical Preparations; Policies; Positioning Attribute; Price; Privatization; Provider; Public Health; Randomized; Randomized Controlled Trials; Regimen; Research; Research Personnel; Resistance; Rewards; Risk; Sales; Savings; Test Result; Testing; Time; Translating; Universities; Work; arm; base; care seeking; cost; cost effectiveness; effective therapy; experimental study; implementation science; improved; ineffective therapies; innovation; mobile application; mortality; payment; point-of-care diagnostics; programs; response; scale up; targeted treatment; uptake; virtual

Project Summary—TESTsmART Trial In 2016, the WHO estimated that 216 million cases of malaria occurred worldwide, yet more than 400 million treatment courses of first-line antimalarials (artemisinin combination therapy or ACT) were consumed. This substantial overuse of ACTs is driven in large part by the private retail sector. More than half of families in sub- Saharan Africa seek treatment for febrile illness in retail medicine outlets where ACT is available over-the- counter, but malaria diagnostic testing is virtually absent and presumptive treatment of fever as malaria is the norm. Availability of inexpensive, donor-subsidized ACTs and the absence of diagnostic testing lead to very poor targeting of ACTs to people who need them. Individuals without malaria consume between 65-90% of ACTs distributed through retail outlets. Unnecessary consumption of ACTs is a drain on scarce public health resources and threatens the future sustainability of publicly-funded subsidies. In addition, it puts both present and future patients at risk by accelerating the spread of drug resistance. Although accurate point of care diagnostics are available for malaria (called rapid diagnostic tests or RDTs), they are uncommon in the retail sector and, where they have been tried, their impact on appropriate ACT use is often poor. We hypothesize that both providers and clients’ decisions about testing and treatment are strongly influenced by price (or profit). In response to this, we propose to test a scalable, policy-relevant strategy that integrates testing and treatment subsidies for the client, with incentives to the provider to test for malaria. ACT subsidies will be available only to customers with a positive malaria test (conditional ACT subsidy). Differential ACT pricing for clients based on the results of the diagnostic test, combined with provider rewards for testing, will align both consumers and providers incentives (price and profit) with testing and appropriate ACT use. In Aim 1, we will use an individually-randomized experiment in Kenya to test the effect of two levels of RDT subsidies and two levels of conditional ACT subsidies on testing uptake among retail outlet clients seeking treatment for malaria- like illnesses. In Aim 2, we will scale-up the combination of testing and treatment subsidies that maximized testing rates in Aim 1 and test their impact, along with incentives to providers’ for testing, on ACT targeting using a cluster-randomized controlled trial in Kenya and Nigeria. Our approach will ensure that public subsidies are directed at confirmed malaria cases thereby enhancing the sustainability of such programs. By allocating subsidy dollars across both testing and conditional treatment (rather than universal, treatment-only subsidies), we can reduce the cost of subsidizing malaria treatment and improve targeting of ACTs without compromising access.

项目摘要-Testsmart试验 2016年，世卫组织估计，全球发生了2.16亿例疟疾病例，但超过4亿 食用了一线抗疟药（青蒿素联合疗法或法案）的治疗课程。这 私人零售部门很大程度上驱动了使徒行传的大量过度使用。超过一半的家庭 撒哈拉非洲寻求治疗零售医学媒体中的高温疾病，这些法案可用 计数器，但疟疾诊断测试几乎没有，并且对发烧的推定治疗是疟疾是 规范。廉价，供体补贴的行为和缺乏诊断测试的可用性导致 对需要行为的人的行为对象很差。没有疟疾的人消耗65-90％ 通过零售商店分发的行为。不必要的行为消费是稀缺的公共卫生 资源并威胁公开资助的补贴的未来可持续性。此外，这两个都在场 和未来的患者通过加速耐药性的扩散来处于危险之中。虽然准确的护理点 诊断可用于疟疾（称为快速诊断测试或RDTS），它们在零售业中并不常见 在尝试过的部门以及他们对适当使用的影响的情况下，通常很差。我们假设 提供者和客户对测试和治疗的决定都受到价格的强烈影响（或 利润）。为此，我们建议测试一项可扩展的与政策相关的策略，以整合测试和 对客户的治疗补贴，并激励提供者测试疟疾。 ACT补贴将是 仅向疟疾阳性测试（有条件ACT补贴）的客户提供。差别行为定价 客户根据诊断测试的结果，结合提供商的测试奖励，将同时调整 消费者和提供者的激励措施（价格和利润），并使用适当的ACT使用。在AIM 1中，我们将 在肯尼亚使用单独随机的实验来测试两种RDT补贴和两种水平的效果 在寻求疟疾治疗的零售渠道客户测试吸收的有条件ACT的补贴水平 喜欢疾病。在AIM 2中，我们将扩大最大化测试和治疗补贴的组合 在AIM 1中测试率并测试其影响，以及对提供者进行测试的激励措施 使用肯尼亚和尼日利亚的集群随机对照试验。我们的方法将确保公众补贴 针对确认的疟疾病例，从而增强了此类计划的可持续性。通过分配 在测试和有条件处理中的补贴美元（而不是普遍的仅处理补贴）， 我们可以降低补贴疟疾治疗的成本并改善行为的目标而没有妥协 使用权。