Trends in availability and prices of subsidized ACT over the first year of the AMFm: evidence from remote regions of Tanzania

Malaria Journal

Research

Oliver Sabot¹  Jessica L Cohen²  Julius Massaga³  Jean Arkedis⁴  Peter S Larson⁵  Sarah Alphs⁶  Prashant Yadav⁷ 

[1] Clinton Health Access Initiative, 383 Dorchester Avenue, Suite 400, 02127, Boston, MA, USA;Harvard School of Public Health, 677 Huntington Avenue, 02115, Boston, MA, USA;National Institute for Medical Research, P.O. Box 9653, Dar es Salaam, Tanzania;Results for Development Institute, 1100 15th Street, NW, Suite 400, Washington, DC S, USA;School of Public Health, University of Michigan, 1415 Washington Heights, 48109, Ann Arbor, MI, USA;The William Davidson Institute, University of Michigan, 724 E University Avenue, 48109, Ann Arbor, MI, USA;The William Davidson Institute, University of Michigan, 724 E University Avenue, 48109, Ann Arbor, MI, USA;Ross School of Business, University of Michigan, 701 Tappan Avenue, 48109, Ann Arbor, MI, USA;School of Public Health, University of Michigan, 1415 Washington Heights, 48109, Ann Arbor, MI, USA;

关键词: Malaria treatment;    ACT;    Anti-malarial subsidy;    AMFm;    Remote availability;    Drug shops;   

DOI  :  10.1186/1475-2875-11-299

 received in 2012-06-15, accepted in 2012-08-15,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundThe Affordable Medicines Facility for malaria (AMFm) is a pilot supra-national subsidy program that aims to increase access and affordability of artemisinin combination therapy (ACT) in public sector clinics and private retail shops. It is unclear to what extent the AMFm model will translate into wide scale availability and price reductions in ACT, particularly for rural, remote areas where disparities in access to medicines often exist. This study is the first to rigorously examine the availability and price of subsidized ACT during the first year of the AMFm, measured through retail audits in remote regions of Tanzania.MethodsPeriodic retail audits of Accredited Drug Dispensing Outlets (ADDOs) were conducted in two remote regions of Tanzania (Mtwara and Rukwa). Temporal and spatial variation in ACT availability and pricing were explored. A composite measure of ADDO remoteness, using variables, such as distance to suppliers and towns, altitude and population density, was used to explore whether ACT availability and price vary systematically with remoteness.ResultsBetween February 2011 and January 2012, the fraction of ADDOs stocking AMFm-ACT increased from 25% to 88% in Mtwara and from 3% to 62% in Rukwa. Availability was widespread, though diffusion throughout the region was achieved more quickly in Mtwara. No significant relationship was found between ACT availability and remoteness. Adult doses of AMFm-ACT were much more widely available than any other age/weight band. Average prices fell from 1529 TZS (1.03 USD) to 1272 TZS (0.81 USD) over the study period, with prices in Rukwa higher than Mtwara. The government recommended retail price for AMFm- ACT is 1,000 TZS ($0.64 USD). The median retail ACT price in the final round of data collection was 1,000 TZS.ConclusionsThe AMFm led to large increases in availability of low priced ACT in Tanzania, with no significant variation in availability based on remoteness. Availability did remain lower and prices remained higher in Rukwa, which is a more remote region overall. Low availability of child and adolescent ACT doses could be due in part to lower quantities of non-adult packs imported into Tanzania. Future research will explore whether increased availability and affordability persists and whether it translates into higher ACT use in Tanzania.

【 授权许可】

Unknown   
© Yadav et al.; licensee BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.