Introducing rapid diagnostic tests for malaria to drug shops in Uganda: a cluster-randomized controlled trial

Abstract

Objective To evaluate the impact – on diagnosis and treatment of malaria – of introducing rapid diagnostic tests to drug shops in eastern Uganda. Methods Overall, 2193 households in 79 study villages with at least one licensed drug shop were enrolled and monitored for 12 months. After 3 months of monitoring, drug shop vendors in 67 villages randomly selected for the intervention were offered training in the use of malaria rapid diagnostic tests and – if trained – offered access to such tests at a subsidized price. The remaining 12 study villages served as controls. A difference-in-differences regression model was used to estimate the impact of the intervention. Findings Vendors from 92 drug shops successfully completed training and 50 actively stocked and performed the rapid tests. Over 9 months, trained vendors did an average of 146 tests per shop. Households reported 22 697 episodes of febrile illness. The availability of rapid tests at local drug shops significantly increased the probability of any febrile illness being tested for malaria by 23.15% ( P = 0.015) and being treated with an antimalarial drug by 8.84% ( P = 0.056). The probability that artemisinin combination therapy was bought increased by a statistically insignificant 5.48% ( P = 0.574). Conclusion In our study area, testing for malaria was increased by training drug shop vendors in the use of rapid tests and providing them access to such tests at a subsidized price. Additional interventions may be needed to achieve a higher coverage of testing and a higher rate of appropriate responses to test results.

Integrated community case management by drug sellers influences appropriate treatment of paediatric febrile illness in South Western Uganda: a quasi-experimental study

“…However, the current study examined the uptake and utilization of these health technologies once available. This is in line with another study [ 63 ] that reported that presence of diagnostics at the drug shops was necessary but not sufficient to translate into their uptake. Other researchers [ 63 , 64 ] have argued that behavioural change efforts and provider incentives are necessary.…”

“…This is in line with another study [ 63 ] that reported that presence of diagnostics at the drug shops was necessary but not sufficient to translate into their uptake. Other researchers [ 63 , 64 ] have argued that behavioural change efforts and provider incentives are necessary. Hence, these findings infer that the iCCM intervention improved the appropriateness of drug seller treatment practices in the intervention arm as compared to the comparison arm.…”

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

“…The fact that most people who tested negative on the RDT decided to still take AL also suggests that patients may have lacked confidence in the RDT result. Though our study design is likely to have biased RDT-negative patients toward taking the medicines, several other studies, across different contexts, have also found high prescription and purchase rates of ACTs despite a negative test result, 28,[48][49][50] likely because there is a tendency in malariaendemic areas for both health workers and patients to treat all fever episodes as malaria. [51][52][53] It may be that over time, as patients learn about the accuracy of the test, RDTs will have a greater impact on adherence.…”

Can malaria rapid diagnostic tests by drug sellers under field conditions classify children 5 years old or less with or without Plasmodium falciparum malaria? Comparison with nested PCR analysis

“…Although appropriate treatment is moderate (55%) in Nigeria [ 17 ] to high (80–99%) in Uganda [ 19 , 21 , 23 ], compliance with negative test results is low. Up to 32% of RDT negative cases in the Ghanaian [ 16 ], 37.4% [ 21 ] and 45% [ 20 ] in the Ugandan, and 51.6% in the Myanmar is studies [ 25 ] receive anti-malarial medicines. In the Tanzanian study [ 24 ], only 7% of the test negative cases received artemisinin-based combination therapy (ACT).…”