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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Piloting the global subsidy: The impact of subsidized artemisinin-based combination therapies distributed through private drug shops in rural Tanzania
PLoS ONE, Volume 4, No. 9, Article e6857, Year 2009
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Description
Background: WHO estimates that only 3% of fever patients use recommended artemisinin-based combination therapies (ACTs), partly reflecting their high prices in the retail sector from where many patients seek treatment. To overcome this challenge, a global ACT subsidy has been proposed. We tested this proposal through a pilot program in rural Tanzania. Methods/Principal Findings: Three districts were assigned to serve either as a control or to receive the subsidy plus a package of supporting interventions. From October 2007, ACTs were sold at a 90% subsidy through the normal private supply chain to intervention district drug shops. Data were collected at baseline and during intervention using interviews with drug shop customers, retail audits, mystery shoppers, and audits of public and NGO facilities. The proportion of consumers in the intervention districts purchasing ACTs rose from 1% at baseline to 44.2% one year later (p<0.001), and was significantly higher among consumers purchasing for children under 5 than for adults (p = 0.005). No change in ACT usage was observed in the control district. Consumers paid a mean price of $0.58 for ACTs, which did not differ significantly from the price paid for sulphadoxine-pyrimethamine, the most common alternative. Drug shops in population centers were significantly more likely to stock ACTs than those in more remote areas (p<0.001). Conclusions: A subsidy introduced at the top of the private sector supply chain can significantly increase usage of ACTs and reduce their retail price to the level of common monotherapies. Additional interventions may be needed to ensure access to ACTs in remote areas and for poorer individuals who appear to seek treatment at drug shops less frequently. © 2009 Sabot et al.
Authors & Co-Authors
Sabot, Oliver
United States, Boston
Clinton Foundation Hiv/aids Initiative
Mwita, Alex
Tanzania, Dar es Salaam
Ministry of Health and Social Welfare
Cohen, Justin M.
United States, Boston
Clinton Foundation Hiv/aids Initiative
Ipuge, Yahya A.I.
Tanzania, Dar es Salaam
Clinton Foundation Hiv/aids Initiative
Gordon, Megumi
United States, Boston
Clinton Foundation Hiv/aids Initiative
Bishop, David
United Kingdom, Surrey
Mott Macdonald Group Limited
Odhiambo, Moses
Kenya, Nairobi
Research Division
Ward, Lorrayne
United States, Cambridge
John F. Kennedy School of Government
Goodman, Catherine A.
Kenya, Nairobi
Kenya Medical Research Institute
Statistics
Citations: 102
Authors: 9
Affiliations: 7
Identifiers
Doi:
10.1371/journal.pone.0006857
e-ISSN:
19326203
Research Areas
Health System And Policy
Maternal And Child Health
Study Design
Randomised Control Trial
Cross Sectional Study
Study Locations
Tanzania