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Project 4: Access

Project 4 - Tanzanian drug shopProject Title

IMPACT 2: Monitoring Interventions to Improve ACT Access and Targeting

Project Location(s)

3 rural regions in mainland Tanzania (Mwanza, Mtwara and Mbeya)

Principal Investigators

Catherine Goodman, London School of Hygiene & Tropical Medicine

S. Patrick Kachur, Malaria Branch, US Centers for Disease Control and Prevention

Salim Abdulla, Ifakara Health Institute

Other Investigators

Ifakara Health Institute

Admirabilis Kaloella
Charles Festo
Boniface Johanes
Happy Nchimbi
Clarence Mkoba 

London School of Hygiene & Tropical Medicine

Katia Bruxvoort
Rebecca Thomson
Matthew Cairns

US Center for Disease Control

Denise Allen
Melissa Briggs

Research Aim(s)

Access: Targeting

Project Background and Rationale

What did we already know about this topic?

It is generally agreed that artemisinin-based combination therapies (ACT) are the best treatment for malaria, but it is less clear how it should be deployed by national programmes. Some countries have started to improve this process, on the one hand, by making ACTs more accessible to patients and, on the other hand, by targeting ACTs more effectively to patients who have malaria.

The government of Tanzania has addressed both ACT access and targeting on a national scale. Poor access has been tackled by the Affordable Medicines Facility-malaria (AMFm), an initiative which distributed subsidised ACTs through public and private facilities, and retail drug shops. Targeting has been addressed through introducing rapid diagnostic tests (RDT) in public health facilities.

What does this study add?

This research has evaluated both AMFm and the roll-out of RDTs in three rural Tanzanian regions, comparing the situation “before and after” the interventions were implemented.  We have used surveys of public health facilities, private antimalarial outlets and households. Through these we have assessed the impact on availability, affordability and quality of treatment, as well as coverage at a community level.

In addition, we conducted a cluster randomised controlled trial to assess how effective sending SMS messages to drug shop staff was in improving the way patients took their ACT medication (known as patient adherence). 

Finally, we have used qualitative methods to explore the socio-cultural context and other factors that influence the implementation and outcome of the two interventions.

Current Status of Project

All fieldwork is now complete, and the project is focusing on the analysis, write up and dissemination of findings.

Download IMPACT2 Policy Brief