Private sector antimalarial sales a decade after “test and treat”: A cross-sectional study of drug shop clients in rural Uganda

Abstract

BackgroundThe World Health Organization has promoted “test and treat” guidelines for malaria since 2010, recommending all suspected malaria cases be confirmed with a parasitological test, typically a rapid diagnostic test (RDT), prior to treatment with antimalarial medications. However, many fevers at private drug shops in Uganda continue to be treated presumptively as malaria without diagnostic testing.MethodsThe purpose of this study was to document private sector malaria case management in rural Uganda through a cross-sectional survey of drug shop clients in Bugoye sub-county. Drug shop vendors (n = 46) recorded information about sales interactions with clients reporting fever or requesting antimalarials and collected capillary blood samples from clients who purchased medications without an RDT. We estimated the proportion of clients who purchased an RDT, adhered to the RDT result, and received antimalarials without having laboratory-confirmed malaria.ResultsMost drug shops were unlicensed (96%) and sold RDTs (98%). Of 934 clients with suspected malaria who visited study drug shops during the data collection period, only 25% bought an RDT. Since some clients reported previous RDTs from the public sector, 40% of clients were aware of their malaria status at the drug shop. Among those with negative tests, 36% still purchased antimalarials. Sixty-five percent of clients who purchased an antimalarial without an RDT subsequently tested negative.ConclusionsDespite national guidelines, drug shop clients who purchase antimalarials from drug shops in Bugoye are often not tested to confirm a malaria diagnosis prior to treatment. Most clients treated presumptively with antimalarials did not have malaria. Interventions are needed to improve malaria case management and rational drug use in the private sector.

A cluster-randomized trial of client and provider-directed financial interventions to align incentives with appropriate case management in retail medicine outlets: Results of the TESTsmART Trial in western Kenya

“…In our study, we demonstrate robust testing rates among clients with suspected malaria and substantially improved ACT targeting among tested clients. Approximately 50% of previously untested clients were tested in study outlets, which is consistent with other implementation studies in the retail sector where mRDTs were not free to the client [28][29][30][31]. Clients were willing to pay for a test prior to treatment, although purchase of an mRDT at the outlet was slightly lower among the poorest wealth quintile.…”

A cluster-randomized trial of client and provider-directed financial interventions to align incentives with appropriate case management in retail medicine outlets: results of the TESTsmART Trial in western Kenya

“…Approximately 50% of previously untested clients were tested in study outlets, which is consistent with other implementation studies in the retail sector where mRDTs were not free to the client. 27–30 Clients were willing to pay for a test prior to treatment, although purchase of an mRDT at the outlet was slightly lower among the poorest wealth quintile. This could indicate that further reducing the price of the test may increase uptake, as was seen in some studies which offered free mRDTs at retail outlets.…”