Subsidising artemisinin-based combination therapy in the private retail sector

Abstract

Background Malaria causes ill health and death in Africa. Treating illness promptly with artemisinin‐based combination therapy (ACT) is likely to cure people and avoid the disease progressing to more severe forms and death. In many countries, ACT use remains low. Part of the problem is that most people seek treatment from the retail sector where ACTs are expensive; this expense is a barrier to their use. The Global Fund and other international organisations are subsidising the cost of ACTs for private retail providers to improve access to ACTs. The subsidy was initially organised through a stand‐alone initiative, called the Affordable Medicines Facility‐malaria (AMFm), but has since been integrated into the Global Fund core grant management and financial processes. Objectives To assess the effect of programmes that include ACT price subsidies for private retailers on ACT use, availability, price and market share. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 1, The Cochrane Library , including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register); MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL (EbscoHost), EconLit (ProQuest), Global Health (OvidSP), Regional Indexes (Global Health Library, WHO), LILACS (Global Health Library, WHO), Science Citation Index and Social Sciences Citation Index (ISI Web of Science) and Health Management (ProQuest). All databases were searched February 2015, except for Health Management which was searched November 2013, without any date, language or publication status restrictions. We also searched the International Clinical Trials Registry Platform (ICTRP; WHO), ClinicalTrials.gov (NIH) and various grey literature sources. We also conducted a cited reference search for all included studies in ISI Web of Knowledge, checked references of identified articles and contacted authors to identify additional studies. Selection criteria Randomised trials, non‐randomised trials, controlled before‐after studies and interrupted‐time‐series studies that compared the effects of ACT price subsidies for private retailers to no subsidies or alternative ACT financing mechanisms were eligible for inclusion. Two authors independently screened and selected studies for inclusion. Data collection and analysis Two review authors independently extracted data, assessed study risk of bias and confidence in effect estimates (certainty of evidence) using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Main results We included four trials (two cluster‐randomised trials reported in three articles and two non‐randomised cluster trials). Three trials assessed retail sector ACT subsidies combined with supportive interventions (retail outlet provider training, community awareness and mass me...

An Overview of the Malaria Epidemic in Sub-Saharan Africa

“…To better serve rural inhabitants, many small communities have created makeshift dispensaries on the side of rural roads (Opiyo, Yamey, & Garner, 2016). However, many of these vendors have not received adequate training on the administration of the medication, such as the required dosage, the drug sched-ule, the requirement to ingest the drug with fatty foods, and instructions on re-administration (Maxmen, 2012).…”

“…In countries where malaria is endemic, the lack of federal training guidelines for public health educators has significantly limited the treatment and control of the disease (Opiyo et al, 2016). For example, patients suspected of having uncomplicated P. falciparum malaria are treated with Artemether Lumefantrine, a common treatment that uses Artemisinin combination therapy (ACT) to provide rapid relief of malaria symptoms in children (Sinclair et al, 2009).…”

“…For example, patients suspected of having uncomplicated P. falciparum malaria are treated with Artemether Lumefantrine, a common treatment that uses Artemisinin combination therapy (ACT) to provide rapid relief of malaria symptoms in children (Sinclair et al, 2009). This therapy can clear 100% of the parasite if given within the first 24 hours of the onset of symptoms (Opiyo et al, 2016). The administration of this therapy would only cost 6-12 USD per person, provided that the dosage and administration of the drug is correctly implemented (Goodman, Coleman, & Mills, 1999).…”

“…The lack of prevalence and incidence data in the rural areas of sub-Saharan Africa makes it difficult to forecast the disease (Opiyo et al, 2016). Because many residents are reluctant to seek treatment when exhibiting malaria symptoms, they often self-prescribe antimalarial drugs, which makes tracking disease prevalence by drug purchase and collecting incidence data problematic (Kone et al, 2013).…”

“…Because many residents are reluctant to seek treatment when exhibiting malaria symptoms, they often self-prescribe antimalarial drugs, which makes tracking disease prevalence by drug purchase and collecting incidence data problematic (Kone et al, 2013). The inability to forecast the disease can make it difficult to predict regional demands of antimalarial drugs, thus creating a shortage of the medication (Opiyo et al, 2016). Moreover, antimalarial drugs expire within six months of the manufacturing date, meaning they cannot be stockpiled (Sinclair et al, 2009).…”