IMPACT 2: Evaluating policies in Tanzania to improve malaria diagnosis and treatment

[Project summary in Français / Português]

Scientific title: IMPACT 2: Monitoring Interventions to Improve ACT Access and Targeting 

What did we know before this research?

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 be 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.

The research team

Principal Investigators:

• Catherine Goodman, London School of Hygiene & Tropical Medicine (catherine.goodman@lshtm.ac.uk)
• S. Patrick Kachur, Malaria Branch, US Centers for Disease Control and Prevention
• Salim Abdulla, Ifakara Health Institute, Tanzania

Other Investigators:

Ifakara Health Institute:

• Admirabilis Kalolella
• Charles Festo
• Boniface Johanes
• Happy Nchimbi
• Clarence Mkoba

London School of Hygiene & Tropical Medicine

• Katia Bruxvoort
• Rebecca Thomson
• Matthew Cairns

US Centers for Disease Control and Prevention

• Denise Allen
• Melissa Briggs