Targeting ACT drugs: the TACT trial
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[Project summary in Français / Português]
Scientific title: A cluster-randomised trial of health worker and community interventions to improve adherence to national guidelines for the use of ACTs in Tanzania
Latest on this research
The TACT trial demonstrated that training health workers for two days decreased the number of ACT prescriptions by approximately 75%. This was a much better effect then was expected and suggests that the tendency of overprescribing malaria drugs is reducing over time. Our analysis has shown that training and motivational SMS had a positive effect on prescribing practices. Also, giving leaflets to patients seemed to improve the way health staff used rapid diagnostic tests.
Scroll down for related resources, including the publication about the main findings of the study: Prescriber and patient-oriented behavioural interventions to improve use of malaria rapid diagnostic tests in Tanzania: Facility-based cluster randomised trial (BMC Medicine)
What did we know before this research?
It is common practice in Africa to overdiagnose malaria, meaning that very often patients are given ACT drugs simply because they present fever. Given the high price of this type of medication, this approach becomes unsustainable. At the same time, it means that patients don’t receive treatment for their actual illness.
Faced with this problem, the World Health Organization introduced revised guidelines for malaria diagnosis and treatment in 2010. Antimalarial treatment should be restricted to patients whose malaria diagnostic result was positive (either through a blood slide or rapid diagnostic test). The National Malaria Control Programme in Tanzania has adopted these recommendations alongside the national scale-up of rapid diagnostic test distribution.
Several studies have now documented two primary problems with rapid diagnostic tests. Firstly, health workers frequently prescribe malaria drugs to patients whose test came negative. Secondly, although tests are available, staff continue to diagnose patients based on their symptoms only.
Because of their accuracy, rapid diagnostic tests are a potential cost-effective solution for malaria overdiagnosis. However, this method only works if health professionals are trained and supervised.
What does this study add?
There is an urgent need to improve the prescription of ACT drugs based on the results of rapid diagnostic tests.
The TACT trial is an intervention in 36 health facilities that may be useful in improving both the management of malaria cases and the treatment of other diseases that also cause fever. The control group of facilities received rapid diagnostic tests and basic training in how to use them. A second arm provided healthworkers with training at the workplace, messages from senior staff and monthy supervision sessions. A third arm provided both healthworkers and community members with the same package as well as a community-based intervention to modify the expectations of patients. Data is collected through exit surveys of patients.
The research team
Principal Investigators
- Dr. Hugh Reyburn, London School of Hygiene & Tropical Medicine
Email: hugh.reyburn@lshtm.ac.uk
- Dr Renata Mandike, Deputy Director, National Malaria Control Programme, Tanzania
- Ms Hilda Mbakilwa, Joint Malaria Programme, Moshi, Tanzania
Other Investigators
- Prof Raimos Olomi, Professor of Paediatrics KCMC, Tanzania
- Dr Steven Magesa, National Institute for Medical Research, Amani Centre, Tanga
- Prof Christopher Whitty, Professor of International Health, London School of Hygiene & Tropical Medicine
- Dr Clare Chandler, Lecturer in Social Science, London School of Hygiene & Tropical Medicine
Related Publications
Treatment guided by rapid diagnostic tests for malaria in Tanzanian children: safety and alternative bacterial diagnoses
George Mtove, Ilse CE Hendriksen, Ben Amos, Hedwiga Mrema, Victor Mandia, Alphaxard Manjurano, Florida Muro, Alma Sykes, Helena Hildenwall, Christopher JM Whitty and Hugh Reyburn | Published
Malaria Journal
The practice of 'doing' evaluation: lessons learned from nine complex intervention trials in action
Joanna R, Deborah D, Lindsay M, Evelyn A, Sham L, Hilda M, Katia B, Jayne W, Lasse V, Shunmay Y, Toby L, Eleanor H, Hugh R, David L, David S, Bonnie C, Sarah S, Virginia W, Catherine G, Clare C | Published
Implementation Science
The development of effective behaviour change interventions to support the use of malaria rapid diagnostic tests by Tanzanian clinicians
Clare IR Chandler, Judith Meta, Clia Ponzo, Fortunata Nasuwa, John Kessy, Hilda Mbakilwa, Ane Haaland, Hugh Reyburn | Published
Implementation Science
Prescriber and patient-oriented behavioural interventions to improve use of malaria rapid diagnostic tests in Tanzania: Facility-based cluster randomised trial
Bonnie Cundill, Hilda Mbakilwa, Clare IR Chandler, George Mtove, Frank Mtei, Annie Willetts, Emily Foster, Florida Muro, Rahim Mwinyishehe, Renata Mandike, Raimos Olomi, Christopher JM Whitty, Hugh Reyburn | Published
BMC Medicine
Bringing the state into the clinic? Incorporating the rapid diagnostic test for malaria into routine practice in Tanzanian primary healthcare facilities
Eleanor Hutchinsona, Hugh Reyburnb, Eleanor Hamlyna, Katie Longa, Judith Metac, Hilda Mbakilwac and Clare Chandlera | Published
Global Public Health
Monitoring patient care through health facility exit interviews: an assessment of the Hawthorne effect in a trial of adherence to malaria treatment guidelines in Tanzania
Baptiste Leurent, Hugh Reyburn, Florida Muro, Hilda Mbakilwa, David Schellenberg | Published
BMC infectious diseases
Examining intervention design: lessons from the development of eight related malaria health care intervention studies
Clare I.R. Chandler*, Helen Burchett, Louise Boyle, Olivia Achonduh, Anthony Mbonye, Deborah DiLiberto, Hugh Reyburn, Obinna Onwujekwe, Ane Haaland, Arantxa Roca-Feltrer, Frank Baiden, Wilfred F. Mbacham, Richard Ndyomugyenyi, Florence Nankya, Lindsay Man | Published
Health Systems and Reform