Improving uptake and use of malaria rapid diagnostic tests in the context of artemisinin drug resistance containment in eastern Myanmar: an evaluation of incentive schemes among informal private healthcare providers

Malaria Journal

Research

Christopher White¹  Thaung Hlaing²  Dominic Montagu³  Ingrid Chen³  May Sudhinaraset³  Willi McFarland³  Christina Briegleb³  Hnin Su Su Khin⁴  Tin Aung⁴  Aung Kyaw San⁴ 

[1] Bill and Melinda Gates Foundation, Seattle, USA;Department of Health, National Malaria Control Programme, Yangon, Myanmar;Global Health Sciences, University of California, San Francisco, CA, USA;Population Services International, Yangon, Myanmar;

关键词: Malaria;    rapid diagnostic tests;    Private providers;    Myanmar;    Intervention;    Incentives;    Artemisinin;    Drug resistance;    Plasmodium falciparum;    Elimination;   

DOI  :  10.1186/s12936-015-0621-7

 received in 2014-11-06, accepted in 2015-02-22,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundAs efforts to contain artemisinin resistance and eliminate Plasmodium falciparum intensify, the accurate diagnosis and prompt effective treatment of malaria are increasingly needed in Myanmar and the Greater Mekong Sub-region (GMS). Rapid diagnostic tests (RDTs) have been shown to be safe, feasible, and effective at promoting appropriate treatment for suspected malaria, which are of particular importance to drug resistance containment. The informal private sector is often the first point of care for fever cases in malaria endemic areas across Myanmar and the GMS, but there is little published information about informal private provider practices, quality of service provision, or potential to contribute to malaria control and elimination efforts. This study tested different incentives to increase RDT use and improve the quality of care among informal private healthcare providers in Myanmar.MethodsThe study randomized six townships in the Mon and Shan states of rural Myanmar into three intervention arms: 1) RDT price subsidies, 2) price subsidies with product-related financial incentives, and 3) price subsidies with intensified information, education and counselling (IEC). The study assessed the uptake of RDT use in the communities by cross-sectional surveys of 3,150 households at baseline and six months post-intervention (6,400 households total, 832 fever cases). The study also used mystery clients among 171 providers to assess quality of service provision across intervention arms.ResultsThe pilot intervention trained over 600 informal private healthcare providers. The study found a price subsidy with intensified IEC, resulted in the highest uptake of RDTs in the community, as compared to subsidies alone or merchandise-related financial incentives. Moreover, intensified IEC led to improvements in the quality of care, with mystery client surveys showing almost double the number of correct treatment following diagnostic test results as compared to a simple subsidy.ConclusionsResults show that training and quality supervision of informal private healthcare providers can result in improved demand for, and appropriate use of RDTs in drug resistance containment areas in eastern Myanmar. Future studies should assess the sustainability of such interventions and the scale and level of intensity required over time as public sector service provision expands.

【 授权许可】

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© Aung et al.; licensee BioMed Central. 2015. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.