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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Closing the access barrier for effective anti-malarials in the private sector in rural Uganda: Consortium for ACT private sector subsidy (CAPSS) pilot study
Malaria Journal, Volume 11, Article 356, Year 2012
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Description
Background: Artemisinin-based combination therapy (ACT), the treatment of choice for uncomplicated falciparum malaria, is unaffordable and generally inaccessible in the private sector, the first port of call for most malaria treatment across rural Africa. Between August 2007 and May 2010, the Uganda Ministry of Health and the Medicines for Malaria Venture conducted the Consortium for ACT Private Sector Subsidy (CAPSS) pilot study to test whether access to ACT in the private sector could be improved through the provision of a high level supply chain subsidy. Methods. Four intervention districts were purposefully selected to receive branded subsidized medicines - "ACT with a leaf", while the fifth district acted as the control. Baseline and evaluation outlet exit surveys and retail audits were conducted at licensed and unlicensed drug outlets in the intervention and control districts. A survey-adjusted, multivariate logistic regression model was used to analyse the intervention's impact on: ACT uptake and price; purchase of ACT within 24 hours of symptom onset; ACT availability and displacement of sub-optimal anti-malarial. Results: At baseline, ACT accounted for less than 1% of anti-malarials purchased from licensed drug shops for children less than five years old. However, at evaluation, "ACT with a leaf" accounted for 69% of anti-malarial purchased in the interventions districts. Purchase of ACT within 24 hours of symptom onset for children under five years rose from 0.8% at baseline to 26.2% (95% CI: 23.2-29.2%) at evaluation in the intervention districts. In the control district, it rose modestly from 1.8% to 5.6% (95% CI: 4.0-7.3%). The odds of purchasing ACT within 24 hours in the intervention districts compared to the control was 0.46 (95% CI: 0.08-2.68, p=0.4) at baseline and significant increased to 6.11 (95% CI: 4.32-8.62, p<0.0001) at evaluation. Children less than five years of age had "ACT with a leaf" purchased for them more often than those aged above five years. There was no evidence of price gouging. Conclusions: These data demonstrate that a supply-side subsidy and an intensive communications campaign significantly increased the uptake and use of ACT in the private sector in Uganda. © 2012 Talisuna et al.; licensee BioMed Central Ltd.
Authors & Co-Authors
Talisuna, Ambrose Otau
Switzerland, Geneve
Medicines for Malaria Venture Mmv
Kenya, Nairobi
Wellcome Trust Research Laboratories Nairobi
Grewal, Penny
Switzerland, Geneve
Medicines for Malaria Venture Mmv
Balyeku, Andrew
Switzerland, Geneve
Medicines for Malaria Venture Mmv
Egan, Timothy
Switzerland, Geneve
Medicines for Malaria Venture Mmv
Piot, Bram
Switzerland, Geneve
Medicines for Malaria Venture Mmv
Coghlan, Renia
Switzerland, Geneve
Medicines for Malaria Venture Mmv
Lugand, Maud Majeres
Switzerland, Geneve
Medicines for Malaria Venture Mmv
Bwire, Godfrey
Switzerland, Geneve
Medicines for Malaria Venture Mmv
Rwakimari, John Bosco
Uganda, Kampala
Uganda Ministry of Health
Ndyomugyenyi, Richard
Uganda, Kampala
Uganda Ministry of Health
Kato, Fred
Uganda, Kampala
Uganda Ministry of Health
Byangire, Maria
Uganda, Kampala
Uganda Ministry of Health
Kagwa, Paul
Uganda, Kampala
Uganda Ministry of Health
Sebisubi, Fred Musoke
Uganda, Kampala
Uganda Ministry of Health
Nahamya, David
Uganda, Kampala
National Drug Authority
Bonabana, Angela
Uganda, Kampala
National Drug Authority
Mpanga-Mukasa, Susan
Uganda, Kampala
Programme for Accessible Communication and Education Pace Uganda
Buyungo, Peter
Uganda, Kampala
Programme for Accessible Communication and Education Pace Uganda
Lukwago, Julius
Uganda, Kampala
Programme for Accessible Communication and Education Pace Uganda
Batte, Allan
Uganda, Kampala
Programme for Accessible Communication and Education Pace Uganda
Nakanwagi, Grace
United Kingdom, London
Malaria Consortium
Tibenderana, James K.
United Kingdom, London
Malaria Consortium
Nayer, Kinny
Uganda, Kampala
Surgipharm Pharmaceuticals
Reddy, Kishore
Uganda, Kampala
Surgipharm Pharmaceuticals
Dokwal, Nilesh
Uganda, Kampala
Surgipharm Pharmaceuticals
Rugumambaju, Sylvester
Netherlands, Woerden
I+solutions
Kidde, Saul
Uganda, Kampala
Management Sciences for Health
Banerji, Jaya
Switzerland, Geneve
Medicines for Malaria Venture Mmv
Jagoe, George
Switzerland, Geneve
Medicines for Malaria Venture Mmv
Statistics
Citations: 29
Authors: 29
Affiliations: 9
Identifiers
Doi:
10.1186/1475-2875-11-356
e-ISSN:
14752875
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Randomised Control Trial
Cross Sectional Study
Study Approach
Quantitative
Study Locations
Uganda