The goal of this study observational study is to test the effect of conditional subsidies for Rapid Diagnostic Tests (RDT) and Artemisinin Combination Therapies (ACT) on improving the management of malaria fevers that seek care in the retail sector. The main question it aims to answer is: • Would a conditional subsidy scheme increase the proportion of clients with malaria receiving an ACT? Researchers will compare the proportion of patients with malaria receiving an ACT in the intervention arms to the control arm. Retail providers in the intervention arm have access to free RDTs and subsidized ACTs distributed by the research team and are asked to use a recommended retail price for the RDT and ACT. In addition, the providers in the intervention arm are trained in the use of RDTs and a mobile app that will prompt them to take and upload a picture of the RDT result. Retail providers in the control arm are trained in the use of RDTs but do not receive free RDTs or subsidized ACTs.
The ultimate goal of the conditional subsidy scheme is to increase the proportion of patients with malaria that receives an artemisinin combination therapy (ACT) at the point of sale. The objective of this study is to test the effect of providing low-cost malaria rapid diagnostic tests (RDT) and Artemisinin Combination Therapies (ACTs) to patients on improving the management of malaria fevers that receive care in private medicine retailers (PMR). During the study, malaria RDTs are provided free of charge to the private provider to conduct malaria-RDT testing at a low cost (at a set recommended retail price) for patients with a malaria-like illness. Subsidized ACTs are provided to the provider, conditional on the provider conducting the malaria RDT and selling the ACT at a low cost to patients testing positive for malaria. Outcomes will be measured by exit interviews on random days each month at participating PMRs.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
20
To promote the use of the recommended first line drug, we implement a conditional subsidy. The retail provider is given the malaria diagnostic for free and is instructed to test clients suspected of having malaria. Only if the test is positive, the provider is instructed to provide the ACT at a low cost.
Private Medicine Retailers
Igabi and Kajuru LGA, Kaduna State, Nigeria
ACT uptake among patients testing positive for malaria during the exit interview
The proportion of patients with malaria that purchased an ACT during their visit to the PMR. For this outcome, a patient with malaria is anyone who has a malaria RDT performed and tests positive at the exit interview.
Time frame: From enrollment exiting the PMR until the rapid test is conducted and the exit interview is concluded (approx 30 min)
Case management of patients visiting the PMR suspected of having malaria
The proportion of patients suspected of malaria cases that are managed appropriately (tested for malaria in the PMR or elsewhere but with proof and purchase any ACT following a positive RDT test result or do not purchase an ACT after a negative RDT rest result)
Time frame: From enrollment exiting the PMR until the rapid test is conducted and the exit interview is concluded (approximately 30 min)]
Out of pocket expenses incurred by patients suspected of having malaria
The out-of-pocket expenses incurred in the PMR by patients suspected of having malaria for ACTs and RDTs
Time frame: From enrollment exiting the PMR until the rapid test is conducted and the exit interview is concluded (approximately 30 min)]
Proportion of untested clients who purchase ACTs
Proportion of clients visiting the PMR that did not test in the drugshop and purchased ACTs
Time frame: From enrollment exiting the PMR until the rapid test is conducted and the exit interview is concluded (approx 30 min)
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