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1
Improving malaria diagnosis & treatment
in the private health sector in Uganda
Anthony Mbonye (MB ChB, PhD)
Director of He...
3
Malaria diagnosis in Uganda
 Rapid diagnostic tests (RDTs) were introduced in public health facilities
in Uganda in 201...
4
What is a registered drug shop?
• Registered with Ministry of Health (National
Drug Authority), licensed to sell Class C...
5
Intervention Design and Outcomes
6
What did the intervention include?
RDT training
based on WHO
generic RDT
training materials
Answering key questions on malaria drug delivery 7
Trial findings:
Adherence to RDTs and targeting of ACTs
Answering key questions on malaria drug delivery 8
9
10
Improved targeting of ACTs
Control group RDT group
Use of RDTs in drug shops: significant increase in proportion of ACT...
Qualitative Evaluation
Answering key questions on malaria drug delivery 11
Aim: To understand more about the processes inv...
12
Support for RDTs in drug shops
Research participants were broadly supportive of the introduction of RDTs
into drug shop...
13
Effect on reputation of shops
……there are those
(project supervisors)
who usually come here
now. If they come and
they ...
14
Conclusions
Summary findings
 RDTs are likely to be popular in the private
retail sector
 Clients are willing to buy ...
15
What has since taken place
 National dissemination meeting of results in Kampala, Sept 2015
 The study results were d...
16
The Policy Environment
 Changing epidemiology of malaria: prevalence reduced from 42% to 9%.
Some areas like Kampala h...
17
Acknowledgments
Principal Investigators
Anthony Mbonye, Ministry of Health, Uganda
Siân Clarke, LSHTM, UK
Pascal Magnus...
18
Please send
questions & comments to
#actdiagnosis
@ACTconsortium
debora.miranda@lshtm.ac.uk
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Improving malaria diagnosis and treatment in the private retail sector in uganda a mbonye

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Presentation by Anthony Mbonye
Principal Investigator, ACT Consortium study in Uganda
Ministry of Health

Published in: Healthcare
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Improving malaria diagnosis and treatment in the private retail sector in uganda a mbonye

  1. 1. 1
  2. 2. Improving malaria diagnosis & treatment in the private health sector in Uganda Anthony Mbonye (MB ChB, PhD) Director of Health Services -Ministry of Health, Uganda & Associate Professor, School of Public Health, Makerere University Answering key questions on malaria drug delivery 2
  3. 3. 3 Malaria diagnosis in Uganda  Rapid diagnostic tests (RDTs) were introduced in public health facilities in Uganda in 2010  Up to 80% of malaria cases are treated in the private sector  Two-arm trial to compare feasibility and impact of using RDTs vs current practice (presumptive treatment of fever) in 65 registered drug shops  Improved targeting of ACTs as primary endpoint: Impact and cost-effectiveness of the intervention on proportion of patients receiving appropriate ACT treatment [with microscopy as gold standard]
  4. 4. 4 What is a registered drug shop? • Registered with Ministry of Health (National Drug Authority), licensed to sell Class C drugs, including antimalarials, but not antibiotics or injections • Most located in or around trading centres (rural and built-up areas) • Typically comprise 1-2 rooms with 1-2 staff • Most have appearance of pharmacies, with drugs displayed on shelves or in glass cabinets • Drug shop vendors smartly dressed, some with white coats • Subject to periodic inspection by District Assistant Drug Inspector
  5. 5. 5 Intervention Design and Outcomes
  6. 6. 6 What did the intervention include? RDT training based on WHO generic RDT training materials
  7. 7. Answering key questions on malaria drug delivery 7
  8. 8. Trial findings: Adherence to RDTs and targeting of ACTs Answering key questions on malaria drug delivery 8
  9. 9. 9
  10. 10. 10 Improved targeting of ACTs Control group RDT group Use of RDTs in drug shops: significant increase in proportion of ACT treatment decisions that were consistent with “true” malaria status [microscopy], p<0.001 33% appropriate 75% appropriatevs.
  11. 11. Qualitative Evaluation Answering key questions on malaria drug delivery 11 Aim: To understand more about the processes involved with the introduction of RDTs at drug shops
  12. 12. 12 Support for RDTs in drug shops Research participants were broadly supportive of the introduction of RDTs into drug shops: • Community members liked RDTs because they allow them to “know the truth about their illness” and stated that they sought out drug shop vendors who could test for malaria and recommended drug shops who carried out RDTs to other community members. • Drug shop vendors reported that they liked to use RDTs and that the availability of RDTs in their shops increases the number of clients, their profitability, their status and diagnostic skills. • Government health-workers were generally in favour of drug shops using RDTs - as long as vendors were well trained, properly supervised and their practice was limited by knowing when to refer patients who they were unable to manage. its not that we studied much but the patients themselves know that we are real health workers, they no longer know us as people only selling drugs. Now they know that we also test what.. even blood. So for us we no longer accept to have our children given treatment before having their blood taken off, because I see now that it is very cheap
  13. 13. 13 Effect on reputation of shops ……there are those (project supervisors) who usually come here now. If they come and they do not disturb him and they do not close his drug shop, we also get encouraged to remain supporting that facility The businesses are up to date and have life in them. You can’t spend a day without working. Even he (the patient) who hadn’t come for testing gets to know that this health provider knows what he is doing - even if he had come with another ailment. After he develops trust in the DSV he brings his children and they get tested and you treat them. Whenever he gets any ailment, he comes, because he has confidence in you. They [patients] see that we are really health workers. This has a way it puts life in us and we feel big, ehhe [yes] and you see yourself becoming big. • Patients were pleased diagnosis was available in drug shops, and felt reassured by the training and supervision of providers with otherwise uncertain credentials • Vendors welcomed the opportunity to demonstrate a new skill and a status more akin to a qualified health worker • Together, the views of drug shop vendors revealed that the intervention had a profound effect on how drug shops were perceived and used. • Highlights the need to consider wider effects of RDT training interventions in the private sector
  14. 14. 14 Conclusions Summary findings  RDTs are likely to be popular in the private retail sector  Clients are willing to buy RDTs at subsidised prices, and trained drug shop vendors can use RDTs and comply with results  RDT training in drug shops can improve targeting of ACTs to malaria patients, and reduce overuse of these drugs  Training to perform tests can also change the reputation of drug shops  RDTs are likely to be financially viable for drug shops: profit from enhanced reputation, increased clientele and sale of other medicine to RDT-negative clients  Referral from shops is uncommon and faces multiple challenges Issues for consideration by program managers  It is feasible to collaborate with the private retail sector to improve malaria treatment  There may be multiple benefits to drug shop vendors in being part of an RDT training programme  Visible government involvement may help promote compliance with guidelines  RDTs could increase popularity of drug shops and affect where patients seek care  RDT use may give a false impression of vendors’ other skills, and could expose patients to less desirable practices.  RDTs should only be introduced within broader accreditation programmes aiming to improve standard of care in private retail sector. Effective regulation by authorities is also needed
  15. 15. 15 What has since taken place  National dissemination meeting of results in Kampala, Sept 2015  The study results were discussed at an international meeting, on introducing RDTs in the private health sector, in Entebbe, Oct 2015  Two meetings have been held involving the Uganda National Drug Authority that registers and regulates drug shops to discuss RDTs in the private sector  A road map has made drawn to draft a guideline for introducing RDTs in the private sector  Draft guidelines have been discussed in the Technical Working Group, Ministry of Health
  16. 16. 16 The Policy Environment  Changing epidemiology of malaria: prevalence reduced from 42% to 9%. Some areas like Kampala have less than 1%. Thus increasing need for testing before treating malaria  Discussions with Ministry of Finance to increase funding for malaria control (for ACTs & IRS) in highly endemic districts of North and Eastern Uganda  Application to Global Fund to purchase RDTs for the community level  A results-based financing strategy could help introduce RDTs in the private sector
  17. 17. 17 Acknowledgments Principal Investigators Anthony Mbonye, Ministry of Health, Uganda Siân Clarke, LSHTM, UK Pascal Magnussen, University of Copenhagen, Denmark Research Team in London Kristian Hansen Sham Lal Eleanor Hutchinson Clare Chandler Bonnie Cundill Caroline Lynch Field Team in Uganda Field co-ordinator: Stephen Kalake Microscopists: Francis Adome, Betty Nabette, Annette Enzaru Social scientists: Miriam Kayendeke, James Kizito, Christine Nabirye, Jonathan Ngobi, Josephine Nabukeera
  18. 18. 18 Please send questions & comments to #actdiagnosis @ACTconsortium debora.miranda@lshtm.ac.uk

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