Can Rapid Diagnostic Testing for Malaria Increase Adherence to Artemether–Lumefantrine?: A Randomized Controlled Trial in Uganda

Abstract

Abstract. Most patients with suspected malaria do not receive diagnostic confirmation before beginning antimalarial treatment. We investigated the extent to which uncertainty about malaria diagnosis contributes to patient nonadherence to artemether-lumefantrine (AL) treatment through a randomized controlled trial in central Uganda. Among 1,525 patients purchasing a course of AL at private drug shops, we randomly offered 37.6% a free malaria rapid diagnostic test (RDT) and then assessed adherence through home visits 3 days later. Of these subjects, 68.4% tested positive for malaria and 65.8% adhered overall. Patients who tested positive did not have significantly higher odds of adherence than those who were not offered the test (adjusted odds ratio [OR]: 1.07, 95% confidence interval [CI]: 0.734-1.57, P = 0.719). Patients who received a positive malaria test had 0.488 fewer pills remaining than those not offered the test (95% CI: −1.02 to 0.043, P = 0.072). We found that patients who felt relatively healthy by the second day of treatment had lower odds of completing treatment (adjusted OR: 0.532, 95% CI: 0.394-0.719, P < 0.001). Our results suggest that diagnostic testing may not improve artemisinin-based combination therapy adherence unless efforts are made to persuade patients to continue taking the full course of drugs even if symptoms have resolved.

The impact of packaging and messaging on adherence to malaria treatment: Evidence from a randomized controlled trial in Uganda

“…A randomized, cross-cutting intervention was conducted in which a rapid diagnostic test (RDT) for malaria was offered to 25% of patients at the time they purchased ACTs. We evaluate the impact of diagnostic testing on adherence in a separate paper and show that a confirmed diagnosis of malaria had no significant effect on adherence ( Saran et al, 2016 ). For the analysis of the packaging and messaging treatments presented here, we always control for the (orthogonal) RDT offer and present robustness checks showing the impact of the treatment arms for the 75% of patients who were not randomly assigned to be offered testing.…”

Predictors of antimalarial self-medication in illegal gold miners in French Guiana: a pathway towards artemisinin resistance

“…A study in Uganda in 2016 reinforced this idea as it found no association between testing and treatment adherence as long as the treatment sent by shop vendors was associated with treatment information. 31 Beside the lack of treatment information, the high cost of the treatment on the black market is another factor leading to poor adherence. In fact, ACTs cost 1 to 3 grams of gold (25 to 90 USD), when miners gain about 10 to 15 grams per week.…”

Adherence to treatment with artemether–lumefantrine or amodiaquine–artesunate for uncomplicated malaria in children in Sierra Leone: a randomized trial

“…For example, although the packaging was part of the outcome definition, the proportion of packaging available was not reported in a number of studies [ 35 , 41 , 42 ]. In others, the package information although collected, was not utilized and only self-reported (probable) adherence rates were reported [ 44 , 63 , 64 ]. In Ghana, an intervention study used package inspection as a secondary outcome to validate self-reported adherence, but found that only 60% of patients were able to produce their package, suggesting that this may not be the most accurate measurement of ACT adherence [ 36 ].…”