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Kalolella A. My Christmas holidays. Cell 2023; 186:672-674. [PMID: 36803596 DOI: 10.1016/j.cell.2023.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 02/18/2023]
Abstract
Admirabilis Kalolella Jr. is the winner of the third annual Rising Black Scientists Award for an undergraduate scholar in the life and health sciences. For this award, we asked emerging Black scientists to tell us about their scientific vision and goals, experiences that sparked their interest in science, how they want to contribute to a more inclusive scientific community, and how these all fit together on their journey. This is his story.
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Packel LJ, de Walque D, Feeney KC, Balampama MP, Cooper JE, Kalolella A, Wechsberg WM, Dow WH. A randomized trial of cash incentives for sexual behavior change among female sex workers in Dar es Salaam. Soc Sci Med 2018; 272:111655. [PMID: 33731255 DOI: 10.1016/j.socscimed.2018.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 02/23/2018] [Accepted: 03/09/2018] [Indexed: 11/30/2022]
Abstract
RATIONALE Female sex workers (FSW) across the world are at high risk for HIV infection and much work is needed to scale up HIV prevention programs among this group. Conditional cash transfer (CCT) programs have been used successfully in recent years to encourage behavior change. We report the results of a CCT intervention among FSW in Tanzania. METHODS We conducted a randomized controlled trial (N = 100) of a CCT intervention among FSW in Dar-es-Salaam, Tanzania in 2013. A respondent-driven sampling approach recruited women and randomized them into two groups based on the value of the cash incentive ($20 vs. $40 per visit). All women received testing for 2 curable sexually transmitted infections (STIs), trichomonas and syphilis, free treatment for those STIs and counseling. Women attended study visits at 0, 2 and 4 months and were tested for STIs and received counseling at each visit. Women testing negative for both STIs at the 2- and 4-month visits received a cash reward. RESULTS Eighty-four women were retained in the study through all three visits. Participants reported significant reductions in the number of clients per week, and increases in the proportion of clients that they used condoms with over the course of the study. STI results showed decreases in prevalence from baseline to final study visit for syphilis and trichomonas. CONCLUSION While this study was not powered to determine if the incentive resulted in statistically significant increases in condom use or decreases in STI prevalence, the results show the acceptability of the intervention, the feasibility of the recruitment methods, and the ability to retain FSW participants across multiple study visits. A follow-up randomized study with a larger number of participants is planned to test the efficacy of the intervention among high-risk populations of women engaging in transactional sex.
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Affiliation(s)
- Laura J Packel
- Office of the President, University of California, 1111 Franklin Street, Oakland, CA 94607, USA.
| | - Damien de Walque
- Development Research Group, The World Bank, 1818 H Street, NW, Washington, DC 20433, USA.
| | - Kevin C Feeney
- School of Public Health, 50 University Hall, #7360, University of California Berkeley, Berkeley, CA 94720-7360, USA.
| | | | - Jan E Cooper
- School of Public Health, 50 University Hall, #7360, University of California Berkeley, Berkeley, CA 94720-7360, USA.
| | - Admirabilis Kalolella
- Ifakara Health Institute, Plot 463, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania, P.O. Box 78373.
| | - Wendee M Wechsberg
- Global Gender Center, RTI International, East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709-2194, USA.
| | - William H Dow
- School of Public Health, 50 University Hall, #7360, University of California Berkeley, Berkeley, CA 94720-7360, USA.
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Thomson R, Johanes B, Festo C, Kalolella A, Taylor M, Tougher S, Ye Y, Mann A, Ren R, Bruxvoort K, Willey B, Arnold F, Hanson K, Goodman C. An assessment of the malaria-related knowledge and practices of Tanzania's drug retailers: exploring the impact of drug store accreditation. BMC Health Serv Res 2018; 18:169. [PMID: 29523139 PMCID: PMC5845369 DOI: 10.1186/s12913-018-2966-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 02/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since 2003 Tanzania has upgraded its approximately 7000 drug stores to Accredited Drug Dispensing Outlets (ADDOs), involving dispenser training, introduction of record keeping and enhanced regulation. Prior to accreditation, drug stores could officially stock over-the-counter medicines only, though many stocked prescription-only antimalarials. ADDOs are permitted to stock 49 prescription-only medicines, including artemisinin combination therapies and one form of quinine injectable. Oral artemisinin monotherapies and other injectables were not permitted at any time. By late 2011 conversion was complete in 14 of 21 regions. We explored variation in malaria-related knowledge and practices of drug retailers in ADDO and non-ADDO regions. METHODS Data were collected as part of the Independent Evaluation of the Affordable Medicines Facility - malaria (AMFm), involving a nationally representative survey of antimalarial retailers in October-December 2011. We randomly selected 49 wards and interviewed all drug stores stocking antimalarials. We compare ADDO and non-ADDO regions, excluding the largest city, Dar es Salaam, due to the unique characteristics of its market. RESULTS Interviews were conducted in 133 drug stores in ADDO regions and 119 in non-ADDO regions. Staff qualifications were very similar in both areas. There was no significant difference in the availability of the first line antimalarial (68.9% in ADDO regions and 65.2% in non-ADDO regions); both areas had over 98% availability of non-artemisinin therapies and below 3.0% of artemisinin monotherapies. Staff in ADDO regions had better knowledge of the first line antimalarial than non-ADDO regions (99.5% and 91.5%, p = 0.001). There was weak evidence of a lower price and higher market share of the first line antimalarial in ADDO regions. Drug stores in ADDO regions were more likely to stock ADDO-certified injectables than those in non-ADDO regions (23.0% and 3.9%, p = 0.005). CONCLUSIONS ADDO conversion is frequently cited as a model for improving retail sector drug provision. Drug stores in ADDO regions performed better on some indicators, possibly indicating some small benefits from ADDO conversion, but also weaknesses in ADDO regulation and high staff turnover. More evidence is needed on the value-added and value for money of the ADDO roll out to inform retail policy in Tanzania and elsewhere.
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Affiliation(s)
| | | | | | | | - Mark Taylor
- London School of Hygiene and Tropical Medicine, London, UK
- International Health Division, ICF International, Calverton, MD USA
| | - Sarah Tougher
- London School of Hygiene and Tropical Medicine, London, UK
| | - Yazoume Ye
- Department of Public Health, Trnava University, Trnava, Slovakia
| | - Andrea Mann
- London School of Hygiene and Tropical Medicine, London, UK
| | - Ruilin Ren
- Department of Public Health, Trnava University, Trnava, Slovakia
| | | | - Barbara Willey
- London School of Hygiene and Tropical Medicine, London, UK
| | - Fred Arnold
- Department of Public Health, Trnava University, Trnava, Slovakia
| | - Kara Hanson
- London School of Hygiene and Tropical Medicine, London, UK
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Tougher S, Mann AG, Ye Y, Kourgueni IA, Thomson R, Amuasi JH, Ren R, Willey BA, Ansong D, Bruxvoort K, Diap G, Festo C, Johanes B, Kalolella A, Mallam O, Mberu B, Ndiaye S, Nguah SB, Seydou M, Taylor M, Wamukoya M, Arnold F, Hanson K, Goodman C. Improving access to malaria medicine through private-sector subsidies in seven African countries. Health Aff (Millwood) 2016; 33:1576-85. [PMID: 25201662 DOI: 10.1377/hlthaff.2014.0104] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Improving access to quality-assured artemisinin combination therapies (ACTs) is an important component of malaria control in low- and middle-income countries. In 2010 the Global Fund to Fight AIDS, Tuberculosis, and Malaria launched the Affordable Medicines Facility--malaria (AMFm) program in seven African countries. The goal of the program was to decrease malaria morbidity and delay drug resistance by increasing the use of ACTs, primarily through subsidies intended to reduce costs. We collected data on price and retail markups on antimalarial medicines from 19,625 private for-profit retail outlets before and 6-15 months after the program's implementation. We found that in six of the AMFm pilot programs, prices for quality-assured ACTs decreased by US$1.28-$4.34, and absolute retail markups on these therapies decreased by US$0.31-$1.03. Prices and markups on other classes of antimalarials also changed during the evaluation period, but not to the same extent. In all but two of the pilot programs, we found evidence that prices could fall further without suppliers' losing money. Thus, concerns may be warranted that wholesalers and retailers are capturing subsidies instead of passing them on to consumers. These findings demonstrate that supranational subsidies can dramatically reduce retail prices of health commodities and that recommended retail prices communicated to a wide audience may be an effective mechanism for controlling the market power of private-sector antimalarial retailers and wholesalers.
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Affiliation(s)
- Sarah Tougher
- Sarah Tougher is a research fellow in the Department of Global Health and Development, London School of Hygiene and Tropical Medicine, in the United Kingdom
| | - Andrea G Mann
- Andrea G. Mann is a lecturer in the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine
| | | | - Yazoume Ye
- Yazoume Ye is a fellow and technical director at ICF International in Rockville, Maryland
| | - Idrissa A Kourgueni
- Idrissa A. Kourgueni is general director of the Centre International d'Etudes et de Recherches sur les Populations Africaines and of the Institut National de la Statistique de Niger, both in Niamey, Niger
| | - Rebecca Thomson
- Rebecca Thomson is a research fellow at the London School of Hygiene and Tropical Medicine
| | - John H Amuasi
- John H. Amuasi is a doctoral candidate in the School of Public Health, University of Minnesota, in Minneapolis, and a researcher at the Komfo Anokye Teaching Hospital (KATH), in Kumasi, Ghana
| | - Ruilin Ren
- Ruilin Ren is a senior technical specialist at ICF International in Rockville, Maryland
| | - Barbara A Willey
- Barbara A. Willey is a lecturer in the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine
| | - Daniel Ansong
- Daniel Ansong is a senior lecturer in the Department of Child Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, and deputy director of the Research and Development Unit, KATH
| | - Katia Bruxvoort
- Katia Bruxvoort is a research fellow at the London School of Hygiene and Tropical Medicine
| | - Graciela Diap
- Graciela Diap is a medical coordinator at the Drugs for Neglected Diseases initiative, in Geneva, Switzerland
| | - Charles Festo
- Charles Festo is a researcher at the Ifakara Health Institute, in Dar es Salaam, Tanzania
| | - Boniface Johanes
- Boniface Johanes is a researcher at the Ifakara Health Institute
| | | | - Oumarou Mallam
- Oumarou Mallam is head of central services at the Institut National de la Statistique du Niger
| | - Blessing Mberu
- Blessing Mberu is a research scientist at the African Population and Health Research Centre (APHRC), in Nairobi, Kenya
| | - Salif Ndiaye
- Salif Ndiaye is director of the Centre de Recherche pour le Développment Humain, in Dakar, Senegal
| | - Samual Blay Nguah
- Samual Blay Nguah is a researcher at the research and development unit at KATH
| | - Moctar Seydou
- Moctar Seydou is a specialist statistician at the Institut National de la Statistique du Niger
| | - Mark Taylor
- Mark Taylor is a Slovak Academic Information Agency (SAIA)-sponsored public health scholar at the University of Trnava, in Slovakia
| | | | - Fred Arnold
- Fred Arnold is a senior fellow at ICF International in Rockville, Maryland
| | - Kara Hanson
- Kara Hanson is a professor of health systems economics and head of the Department of Global Health and Development at the London School of Hygiene and Tropical Medicine
| | - Catherine Goodman
- Catherine Goodman is a senior lecturer in health economics and policy at the London School of Hygiene and Tropical Medicine
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Baraka J, Rusibamayila A, Kalolella A, Baynes C. Challenges Addressing Unmet Need for Contraception: Voices of Family Planning Service Providers in Rural Tanzania. Afr J Reprod Health 2015; 19:23-30. [PMID: 27337850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Provider perspectives have been overlooked in efforts to address the challenges of unmet need for family planning (FP). This qualitative study was undertaken in Tanzania, using 22 key informant interviews and 4 focus group discussions. The research documents perceptions of healthcare managers and providers in a rural district on the barriers to meeting latent demand for contraception. Social-ecological theory is used to interpret the findings, illustrating how service capability is determined by the social, structural and organizational environment. Providers' efforts to address unmet need for FP services are constrained by unstable reproductive preferences, low educational attainment, and misconceptions about contraceptive side effects. Societal and organizational factors--such as gender dynamics, economic conditions, religious and cultural norms, and supply chain bottlenecks, respectively--also contribute to an adverse environment for meeting needs for care. Challenges that healthcare providers face interact and produce an effect which hinders efforts to address unmet need. Interventions to address this are not sufficient unless the supply of services is combined with systems strengthening and social engagement strategies in a way that reflects the multi-layered, social institutional problems.
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Bruxvoort K, Festo C, Cairns M, Kalolella A, Mayaya F, Kachur SP, Schellenberg D, Goodman C. Measuring Patient Adherence to Malaria Treatment: A Comparison of Results from Self-Report and a Customised Electronic Monitoring Device. PLoS One 2015. [PMID: 26214848 PMCID: PMC4516331 DOI: 10.1371/journal.pone.0134275] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Self-report is the most common and feasible method for assessing patient adherence to medication, but can be prone to recall bias and social desirability bias. Most studies assessing adherence to artemisinin-based combination therapies (ACTs) have relied on self-report. In this study, we use a novel customised electronic monitoring device--termed smart blister packs--to examine the validity of self-reported adherence to artemether-lumefantrine (AL) in southern Tanzania. METHODS Smart blister packs were designed to look identical to locally available AL blister packs and to record the date and time each tablet was removed from packaging. Patients obtaining AL at randomly selected health facilities and drug stores were followed up at home three days later and interviewed about each dose of AL taken. Blister packs were requested for pill count and extraction of smart blister pack data. RESULTS Data on adherence from both self-report verified by pill count and smart blister packs were available for 696 of 1,204 patients. There was no difference between methods in the proportion of patients assessed to have completed treatment (64% and 67%, respectively). However, the percentage taking the correct number of pills for each dose at the correct times (timely completion) was higher by self-report than smart blister packs (37% vs. 24%; p<0.0001). By smart blister packs, 64% of patients completing treatment did not take the correct number of pills per dose or did not take each dose at the correct time interval. CONCLUSION Smart blister packs resulted in lower estimates of timely completion of AL and may be less prone to recall and social desirability bias. They may be useful when data on patterns of adherence are desirable to evaluate treatment outcomes. Improved methods of collecting self-reported data are needed to minimise bias and maximise comparability between studies.
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Affiliation(s)
- Katia Bruxvoort
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Impact Evaluation Thematic Group, Ifakara Health Institute, Dar es Salaam, Tanzania
- * E-mail:
| | - Charles Festo
- Impact Evaluation Thematic Group, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Matthew Cairns
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Frank Mayaya
- Impact Evaluation Thematic Group, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - S. Patrick Kachur
- Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, United States of America
| | - David Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Catherine Goodman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Poyer S, Shewchuk T, Tougher S, Ye Y, Mann AG, Willey BA, Thomson R, Amuasi JH, Ren R, Wamukoya M, Taylor M, Nguah SB, Mberu B, Kalolella A, Juma E, Festo C, Johanes B, Diap G, Bruxvoort K, Ansong D, Hanson K, Arnold F, Goodman C. Availability and price of malaria rapid diagnostic tests in the public and private health sectors in 2011: results from 10 nationally representative cross-sectional retail surveys. Trop Med Int Health 2015; 20:744-56. [DOI: 10.1111/tmi.12491] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Stephen Poyer
- Malaria & Child Survival Department; Population Services International; Nairobi Kenya
| | | | - Sarah Tougher
- London School of Hygiene and Tropical Medicine; London UK
| | | | - Andrea G. Mann
- London School of Hygiene and Tropical Medicine; London UK
| | | | - Rebecca Thomson
- London School of Hygiene and Tropical Medicine; London UK
- Ifakara Health Institute; Dar es Salaam Tanzania
| | - John H. Amuasi
- University of Minnesota School of Public Health; Minneapolis MN USA
- Kumasi Center for Collaborative Research in Tropical Medicine; Kumasi Ghana
| | | | | | - Mark Taylor
- London School of Hygiene and Tropical Medicine; London UK
- Department of Public Health; Trnava University; Trnava Slovakia
| | - Samuel Blay Nguah
- Kumasi Center for Collaborative Research in Tropical Medicine; Kumasi Ghana
| | - Blessing Mberu
- African Population and Health Research Center; Nairobi Kenya
| | | | - Elizabeth Juma
- Kenya Medical Research Institute; Centre for Global Health Research; Kisumu Kenya
| | | | | | - Graciela Diap
- Drugs for Neglected Diseases Initiative; Geneva Switzerland
| | - Katia Bruxvoort
- London School of Hygiene and Tropical Medicine; London UK
- Ifakara Health Institute; Dar es Salaam Tanzania
| | - Daniel Ansong
- African Population and Health Research Center; Nairobi Kenya
- Department of Child Health; Kwame Nkrumah University of Science & Technology; Kumasi Ghana
| | - Kara Hanson
- London School of Hygiene and Tropical Medicine; London UK
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Bruxvoort K, Kalolella A, Cairns M, Festo C, Kenani M, Lyaruu P, Kachur SP, Schellenberg D, Goodman C. Are Tanzanian patients attending public facilities or private retailers more likely to adhere to artemisinin-based combination therapy? Malar J 2015; 14:87. [PMID: 25889767 PMCID: PMC4340668 DOI: 10.1186/s12936-015-0602-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 02/02/2015] [Indexed: 11/30/2022] Open
Abstract
Background Artemisinin combination therapy (ACT) is first-line treatment for malaria in most endemic countries and is increasingly available in the private sector. Most studies on ACT adherence have been conducted in the public sector, with minimal data from private retailers. Methods Parallel studies were conducted in Tanzania, in which patients obtaining artemether-lumefantrine (AL) at 40 randomly selected public health facilities and 37 accredited drug dispensing outlets (ADDOs) were visited at home and questioned about doses taken. The effect of sector on adherence, controlling for potential confounders was assessed using logistic regression with a random effect for outlet. Results Of 572 health facility patients and 450 ADDO patients, 74.5% (95% CI: 69.8, 78.8) and 69.8% (95% CI: 64.6, 74.5), respectively, completed treatment and 46.0% (95% CI: 40.9, 51.2) and 34.8% (95% CI: 30.1, 39.8) took each dose at the correct time (‘timely completion’). ADDO patients were wealthier, more educated, older, sought care later in the day, and were less likely to test positive for malaria than health facility patients. Controlling for patient characteristics, the adjusted odds of completed treatment and of timely completion for ADDO patients were 0.65 (95% CI: 0.43, 1.00) and 0.69 (95% CI: 0.47, 1.01) times that of health facility patients. Higher socio-economic status was associated with both adherence measures. Higher education was associated with completed treatment (adjusted OR = 1.68, 95% CI: 1.20, 2.36); obtaining AL in the evening was associated with timely completion (adjusted OR = 0.35, 95% CI: 0.19, 0.64). Factors associated with adherence in each sector were examined separately. In both sectors, recalling correct instructions was positively associated with both adherence measures. In health facility patients, but not ADDO patients, taking the first dose of AL at the outlet was associated with timely completion (adjusted OR = 2.11, 95% CI: 1.46, 3.04). Conclusion When controlling for patient characteristics, there was some evidence that the adjusted odds of adherence for ADDO patients was lower than that for public health facility patients. Better understanding is needed of which patient care aspects are most important for adherence, including the role of effective provision of advice. Electronic supplementary material The online version of this article (doi:10.1186/s12936-015-0602-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Matthew Cairns
- London School of Hygiene and Tropical Medicine, London, UK.
| | | | - Mitya Kenani
- Ifakara Health Institute, Dar es Salaam, Tanzania.
| | - Peter Lyaruu
- Ifakara Health Institute, Dar es Salaam, Tanzania.
| | - S Patrick Kachur
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, USA.
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Bruxvoort K, Festo C, Kalolella A, Cairns M, Lyaruu P, Kenani M, Kachur SP, Goodman C, Schellenberg D. Cluster randomized trial of text message reminders to retail staff in tanzanian drug shops dispensing artemether-lumefantrine: effect on dispenser knowledge and patient adherence. Am J Trop Med Hyg 2014; 91:844-853. [PMID: 25002300 PMCID: PMC4183415 DOI: 10.4269/ajtmh.14-0126] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Artemisinin combination therapies are available in private outlets, but patient adherence might be compromised by poor advice from dispensers. In this cluster randomized trial in drug shops in Tanzania, 42 of 82 selected shops were randomized to receive text message reminders about what advice to provide when dispensing artemether-lumefantrine (AL). Eligible patients purchasing AL at shops in both arms were followed up at home and questioned about each dose taken. Dispensers were interviewed regarding knowledge of AL dispensing practices and receipt of the malaria-related text messages. We interviewed 904 patients and 110 dispensers from 77 shops. Although there was some improvement in dispenser knowledge, there was no difference between arms in adherence measured as completion of all doses (intervention 68.3%, control 69.8%, p [adjusted] = 0.6), or as completion of each dose at the correct time (intervention 33.1%, control 32.6%, p [adjusted] = 0.9). Further studies on the potential of text messages to improve adherence are needed.
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Affiliation(s)
- Katia Bruxvoort
- *Address correspondence to Katia Bruxvoort, 15-17 Tavistock Place, London, WC1H 9SH. E-mail:
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Thomson R, Festo C, Johanes B, Kalolella A, Bruxvoort K, Nchimbi H, Tougher S, Cairns M, Taylor M, Kleinschmidt I, Ye Y, Mann A, Ren R, Willey B, Arnold F, Hanson K, Kachur SP, Goodman C. Has Tanzania embraced the green leaf? Results from outlet and household surveys before and after implementation of the Affordable Medicines Facility-malaria. PLoS One 2014; 9:e95607. [PMID: 24816649 PMCID: PMC4015933 DOI: 10.1371/journal.pone.0095607] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 03/28/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Affordable Medicines Facility-malaria (AMFm) is primarily an artemisinin combination therapy (ACT) subsidy, aimed at increasing availability, affordability, market share and use of quality-assured ACTs (QAACTs). Mainland Tanzania was one of eight national scale programmes where AMFm was introduced in 2010. Here we present findings from outlet and household surveys before and after AMFm implementation to evaluate its impact from both the supply and demand side. METHODS Outlet surveys were conducted in 49 randomly selected wards throughout mainland Tanzania in 2010 and 2011, and data on outlet characteristics and stocking patterns were collected from outlets stocking antimalarials. Household surveys were conducted in 240 randomly selected enumeration areas in three regions in 2010 and 2012. Questions about treatment seeking for fever and drugs obtained were asked of individuals reporting fever in the previous two weeks. RESULTS The availability of QAACTs increased from 25.5% to 69.5% among all outlet types, with the greatest increase among pharmacies and drug stores, together termed specialised drug sellers (SDSs), where the median QAACT price fell from $5.63 to $0.94. The market share of QAACTs increased from 26.2% to 42.2%, again with the greatest increase in SDSs. Household survey results showed a shift in treatment seeking away from the public sector towards SDSs. Overall, there was no change in the proportion of people with fever obtaining an antimalarial or ACT from baseline to endline. However, when broken down by treatment source, ACT use increased significantly among clients visiting SDSs. DISCUSSION Unchanged ACT use overall, despite increases in QAACT availability, affordability and market share in the private sector, reflected a shift in treatment seeking towards private providers. The reasons for this shift are unclear, but likely reflect both persistent stockouts in public facilities, and the increased availability of subsidised ACTs in the private sector.
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Affiliation(s)
- Rebecca Thomson
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Ifakara Health Institute, Dar es Salaam, Tanzania
- * E-mail:
| | | | | | | | - Katia Bruxvoort
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Sarah Tougher
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matthew Cairns
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mark Taylor
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Public Health, Trnava University, Trnava, Slovakia
| | - Immo Kleinschmidt
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Yazoume Ye
- International Health Division, ICF International, Calverton, Maryland, United States of America
| | - Andrea Mann
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ruilin Ren
- International Health Division, ICF International, Calverton, Maryland, United States of America
| | - Barbara Willey
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Fred Arnold
- International Health Division, ICF International, Calverton, Maryland, United States of America
| | - Kara Hanson
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - S. Patrick Kachur
- Malaria Branch, Centers for Disease Control & Prevention, Atlanta, Georgia, United States of America
| | - Catherine Goodman
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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Briggs MA, Kalolella A, Bruxvoort K, Wiegand R, Lopez G, Festo C, Lyaruu P, Kenani M, Abdulla S, Goodman C, Kachur SP. Prevalence of malaria parasitemia and purchase of artemisinin-based combination therapies (ACTs) among drug shop clients in two regions in Tanzania with ACT subsidies. PLoS One 2014; 9:e94074. [PMID: 24732258 PMCID: PMC3986050 DOI: 10.1371/journal.pone.0094074] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 03/11/2014] [Indexed: 11/17/2022] Open
Abstract
Background Throughout Africa, many people seek care for malaria in private-sector drug shops where diagnostic testing is often unavailable. Recently, subsidized artemisinin-based combination therapies (ACTs), a first-line medication for uncomplicated malaria, were made available in these drug shops in Tanzania. This study assessed the prevalence of malaria among and purchase of ACTs by drug shop clients in the setting of a national ACT subsidy program and sub-national drug shop accreditation program. Method and Findings A cross-sectional survey of drug shop clients was performed in two regions in Tanzania, one with a government drug shop accreditation program and one without, from March-May, 2012. Drug shops were randomly sampled from non-urban districts. Shop attendants were interviewed about their education, training, and accreditation status. Clients were interviewed about their symptoms and medication purchases, then underwent a limited physical examination and laboratory testing for malaria. Malaria prevalence and predictors of ACT purchase were assessed using univariate analysis and multiple logistic regression. Amongst 777 clients from 73 drug shops, the prevalence of laboratory-confirmed malaria was 12% (95% CI: 6–18%). Less than a third of clients with malaria had purchased ACTs, and less than a quarter of clients who purchased ACTs tested positive for malaria. Clients were more likely to have purchased ACTs if the participant was <5 years old (aOR: 6.6; 95% CI: 3.9–11.0) or the shop attendant had >5 years, experience (aOR: 2.8; 95% CI: 1.2–6.3). Having malaria was only a predictor of ACT purchase in the region with a drug shop accreditation program (aOR: 3.4; 95% CI: 1.5–7.4). Conclusion Malaria is common amongst persons presenting to drug shops with a complaint of fever. The low proportion of persons with malaria purchasing ACTs, and the high proportion of ACTs going to persons without malaria demonstrates a need to better target who receives ACTs in these drug shops.
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Affiliation(s)
- Melissa A Briggs
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Katia Bruxvoort
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ryan Wiegand
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Gerard Lopez
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Mitya Kenani
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Catherine Goodman
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - S Patrick Kachur
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Willey BA, Tougher S, Ye Y, Mann AG, Thomson R, Kourgueni IA, Amuasi JH, Ren R, Wamukoya M, Rueda ST, Taylor M, Seydou M, Nguah SB, Ndiaye S, Mberu B, Malam O, Kalolella A, Juma E, Johanes B, Festo C, Diap G, Diallo D, Bruxvoort K, Ansong D, Amin A, Adegoke CA, Hanson K, Arnold F, Goodman C. Communicating the AMFm message: exploring the effect of communication and training interventions on private for-profit provider awareness and knowledge related to a multi-country anti-malarial subsidy intervention. Malar J 2014; 13:46. [PMID: 24495691 PMCID: PMC3924415 DOI: 10.1186/1475-2875-13-46] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 01/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Affordable Medicines Facility - malaria (AMFm), implemented at national scale in eight African countries or territories, subsidized quality-assured artemisinin combination therapy (ACT) and included communication campaigns to support implementation and promote appropriate anti-malarial use. This paper reports private for-profit provider awareness of key features of the AMFm programme, and changes in provider knowledge of appropriate malaria treatment. METHODS This study had a non-experimental design based on nationally representative surveys of outlets stocking anti-malarials before (2009/10) and after (2011) the AMFm roll-out. RESULTS Based on data from over 19,500 outlets, results show that in four of eight settings, where communication campaigns were implemented for 5-9 months, 76%-94% awareness of the AMFm 'green leaf' logo, 57%-74% awareness of the ACT subsidy programme, and 52%-80% awareness of the correct recommended retail price (RRP) of subsidized ACT were recorded. However, in the remaining four settings where communication campaigns were implemented for three months or less, levels were substantially lower. In six of eight settings, increases of at least 10 percentage points in private for-profit providers' knowledge of the correct first-line treatment for uncomplicated malaria were seen; and in three of these the levels of knowledge achieved at endline were over 80%. CONCLUSIONS The results support the interpretation that, in addition to the availability of subsidized ACT, the intensity of communication campaigns may have contributed to the reported levels of AMFm-related awareness and knowledge among private for-profit providers. Future subsidy programmes for anti-malarials or other treatments should similarly include communication activities.
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Affiliation(s)
- Barbara A Willey
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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13
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Bruxvoort K, Kalolella A, Nchimbi H, Festo C, Taylor M, Thomson R, Cairns M, Thwing J, Kleinschmidt I, Goodman C, Kachur SP. Getting antimalarials on target: impact of national roll-out of malaria rapid diagnostic tests on health facility treatment in three regions of Tanzania. Trop Med Int Health 2013; 18:1269-82. [PMID: 23937722 PMCID: PMC4282336 DOI: 10.1111/tmi.12168] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objectives Parasitological confirmation of malaria prior to treatment is recommended for patients of all ages, with malaria rapid diagnostic tests (mRDTs) an important tool to target artemisinin-based combination therapies (ACTs) to patients with malaria. To evaluate the impact on case management practices of routine government implementation of mRDTs, we conducted large-scale health facility surveys in three regions of Tanzania before and after mRDT roll-out. Methods Febrile patients at randomly selected health facilities were interviewed about care received at the facility, and blood samples were collected for reference blood smears. Health facility staff were interviewed about their qualifications and availability of malaria diagnostics and drugs. Results The percentage of febrile patients tested for malaria at the facility increased from 15.8% in 2010 to 54.9% in 2012. ACTs were obtained by 65.8% of patients positive by reference blood smear in 2010 and by 50.2% in 2012 (P = 0.0675); no antimalarial was obtained by 57.8% of malaria-negative patients in 2010 and by 82.3% in 2012 (P < 0.0001). Overall, ACT use decreased (39.9–21.3%, P < 0.0001) and antibiotic use increased (31.2–48.5%, P < 0.0001). Conclusion Roll-out of mRDTs in Tanzania dramatically improved diagnostic testing for malaria and reduced overuse of ACTs for patients without parasitemia. However, post–roll-out almost 50% of febrile patients did not receive a diagnostic test, and almost 50% of patients testing positive did not receive ACTs. Stock-outs of ACTs and mRDTs were important problems. Further investigation is needed to determine reasons for not providing ACTs to patients with malaria and potential for inappropriate antibiotic use.
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Affiliation(s)
- Katia Bruxvoort
- London School of Hygiene and Tropical Medicine, London, UK; Ifakara Health Institute, Dar es Salaam, Tanzania
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14
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Tougher S, Ye Y, Amuasi JH, Kourgueni IA, Thomson R, Goodman C, Mann AG, Ren R, Willey BA, Adegoke CA, Amin A, Ansong D, Bruxvoort K, Diallo DA, Diap G, Festo C, Johanes B, Juma E, Kalolella A, Malam O, Mberu B, Ndiaye S, Nguah SB, Seydou M, Taylor M, Rueda ST, Wamukoya M, Arnold F, Hanson K. Effect of the Affordable Medicines Facility--malaria (AMFm) on the availability, price, and market share of quality-assured artemisinin-based combination therapies in seven countries: a before-and-after analysis of outlet survey data. Lancet 2012; 380:1916-26. [PMID: 23122217 DOI: 10.1016/s0140-6736(12)61732-2] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Malaria is one of the greatest causes of mortality worldwide. Use of the most effective treatments for malaria remains inadequate for those in need, and there is concern over the emergence of resistance to these treatments. In 2010, the Global Fund launched the Affordable Medicines Facility--malaria (AMFm), a series of national-scale pilot programmes designed to increase the access and use of quality-assured artemisinin based combination therapies (QAACTs) and reduce that of artemisinin monotherapies for treatment of malaria. AMFm involves manufacturer price negotiations, subsidies on the manufacturer price of each treatment purchased, and supporting interventions such as communications campaigns. We present findings on the effect of AMFm on QAACT price, availability, and market share, 6-15 months after the delivery of subsidised ACTs in Ghana, Kenya, Madagascar, Niger, Nigeria, Uganda, and Tanzania (including Zanzibar). METHODS We did nationally representative baseline and endpoint surveys of public and private sector outlets that stock antimalarial treatments. QAACTs were identified on the basis of the Global Fund's quality assurance policy. Changes in availability, price, and market share were assessed against specified success benchmarks for 1 year of AMFm implementation. Key informant interviews and document reviews recorded contextual factors and the implementation process. FINDINGS In all pilots except Niger and Madagascar, there were large increases in QAACT availability (25·8-51·9 percentage points), and market share (15·9-40·3 percentage points), driven mainly by changes in the private for-profit sector. Large falls in median price for QAACTs per adult equivalent dose were seen in the private for-profit sector in six pilots, ranging from US$1·28 to $4·82. The market share of oral artemisinin monotherapies decreased in Nigeria and Zanzibar, the two pilots where it was more than 5% at baseline. INTERPRETATION Subsidies combined with supporting interventions can be effective in rapidly improving availability, price, and market share of QAACTs, particularly in the private for-profit sector. Decisions about the future of AMFm should also consider the effect on use in vulnerable populations, access to malaria diagnostics, and cost-effectiveness. FUNDING The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Bill & Melinda Gates Foundation.
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Affiliation(s)
- Sarah Tougher
- London School of Hygiene and Tropical Medicine, London, UK.
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