Incentivizing appropriate malaria case management in the private sector: a study protocol for two linked cluster randomized controlled trials to evaluate provider- and client-focused interventions in western Kenya and Lagos, Nigeria

Implementation Science

Joseph Kipkoech¹  Emmah Kimachas¹  George Ambani¹  Jeremiah Laktabai²  Chizoba Fashanu³  Owens Wiwa³  Theodoor Visser⁴  Aaron M. Woolsey⁴  Bomar Mendez Rojas⁴  Meley Woldeghebriel⁴  Mercy Odhiambo⁴  Oluwatosin Ogunsola⁵  Tayo Olaleye⁵  Diana Menya⁶  Josephine Malinga⁷  Sarah Laing⁷  Wendy Prudhomme O’Meara⁸  Ryan A. Simmons⁹  Elizabeth L. Turner⁹  Yunji Zhou⁹  Indrani Saran^1,10 

[1] Academic Model Providing Access to Healthcare, Moi University, Eldoret, Kenya;Academic Model Providing Access to Healthcare, Moi University, Eldoret, Kenya;College of Health Sciences, Moi University School of Medicine, Eldoret, Kenya;Clinton Health Access Initiative, Abuja, Nigeria;Clinton Health Access Initiative, Boston, MA, USA;Clinton Health Access Initiative, Lagos, Nigeria;College of Health Sciences, Moi University School of Public Health, Eldoret, Kenya;Duke Global Health Institute, Duke University, Durham, NC, USA;Duke Global Health Institute, Duke University, Durham, NC, USA;College of Health Sciences, Moi University School of Public Health, Eldoret, Kenya;Department of Medicine, Duke University, Durham, NC, USA;Duke Global Health Institute, Duke University, Durham, NC, USA;Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA;School of Social Work, Boston College, Boston, MA, USA;

关键词: Malaria;    Private sector;    ACT;    RDT;    Subsidy;    Subsidies;   

DOI  :  10.1186/s13012-020-01077-w

来源: Springer

【 摘 要 】

BackgroundA large proportion of artemisinin-combination therapy (ACT) anti-malarial medicines is consumed by individuals that do not have malaria. The over-consumption of ACTs is largely driven by retail sales in high malaria-endemic countries to clients who have not received a confirmatory diagnosis. This study aims to target ACT sales to clients receiving a confirmatory diagnosis using malaria rapid diagnostic tests (mRDTs) at retail outlets in Kenya and Nigeria.MethodsThis study comprises two linked four-arm 2 × 2 factorial cluster randomized controlled trials focused on malaria diagnostic testing and conditional ACT subsidies with the goal to evaluate provider-directed and client-directed interventions. The linked trials will be conducted at two contrasting study sites: a rural region around Webuye in western Kenya and the urban center of Lagos, Nigeria. Clusters are 41 and 48 participating retail outlets in Kenya and Nigeria, respectively. Clients seeking care at participating outlets across all arms will be given the option of paying for a mRDT—at a study-recommended price—to be conducted at the outlet. In the provider-directed intervention arm, the outlet owner receives a small monetary incentive to perform the mRDT. In the client-directed intervention arm, the client receives a free ACT if they purchase an mRDT and receive a positive test result. Finally, the fourth study arm combines both the provider- and client-directed interventions. The diagnosis and treatment choices made during each transaction will be captured using a mobile phone app. Study outcomes will be collected through exit interviews with clients, who sought care for febrile illness, at each of the enrolled retail outlets.ResultsThe primary outcome measure is the proportion of all ACTs that are sold to malaria test-positive clients in each study arm. For all secondary outcomes, we will evaluate the degree to which the interventions affect purchasing behavior among people seeking care for a febrile illness at the retail outlet.ConclusionsIf our study demonstrates that malaria case management can be improved in the retail sector, it could reduce overconsumption of ACTs and enhance targeting of publicly funded treatment reimbursements, lowering the economic barrier to appropriate diagnosis and treatment for patients with malaria.Trial registrationClinicalTrials.govNCT04428307, registered June 9, 2020, and NCT04428385, registered June 9, 2020.

【 授权许可】

CC BY