A cluster-randomized trial of client and provider directed financial interventions to align incentives with appropriate case management in private medicine retailers

Results of the TestsmART trial in Lagos, Nigeria

Bibliographic Data

ID19593412
AuthorsTheodoor Visser (0000-0002-5669-027X, Clinton Health Access Initiative, corresponding author), Jeremiah Laktabai (0000-0003-2198-6414, Moi University, corresponding author), Emmah Kimachas (0009-0007-8487-9516, AMPATH, corresponding author), Joseph Kipkoech Kirui (0000-0001-5833-7608), Joseph Kipkoech (AMPATH, corresponding author), Diana Menya (0000-0003-3708-1871, Moi University, corresponding author), David Arthur (0000-0002-3732-3618, Duke University, corresponding author), Yunji Zhou (0000-0002-3610-9257, University of Washington, corresponding author), Tabitha Chepkwony (AMPATH, corresponding author), Lucy Abel (0000-0001-5857-1269, Moi University, corresponding author), Emily Robie (0000-0002-0928-7859, Duke University, corresponding author), Mark Amunga (0009-0001-7088-4994, AMPATH, corresponding author), George Ambani (AMPATH, corresponding author), Perpetua Uhomoibhi (Federal Ministry of Health, corresponding author), Nnenna Ogbulafor (Federal Ministry of Health, corresponding author), Abimbola Oshinowo (Lagos State Health Service Commission, corresponding author), Oluwatosin Ogunsola (University of Rochester, corresponding author), Meley Woldeghebriel (0000-0003-2583-6819, corresponding author), Elizabeth Garber (0000-0003-1152-307X, corresponding author), Tayo Olaleye (corresponding author), Nwamaka Eze, Nwamaka A Eze (corresponding author), Lekia Nwidae (corresponding author), Pamela Mudabai (corresponding author), John A Gallis, John Gallis (0000-0003-1921-8424, Duke University, corresponding author), Chizoba Fashanu (corresponding author), Indrani Saran (0000-0001-7416-652X, Boston College, corresponding author), Aaron Woolsey (0000-0002-9101-9844, Clinton Health Access Initiative, corresponding author), Owens Wiwa (corresponding author), E L Turner (0000-0002-7638-5942, Duke University, corresponding author), Wendy Prudhomme O’meara (0000-0001-9455-3965, Duke Institute for Health Innovation, corresponding author)
EditorsMuhammed O Afolabi (0000-0002-9967-6419)
Year2024
Volume4
Issue7
Pagese0002938
Publication date2024-07-02
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0002938
PMID38954701
OpenAlexW4400229629
LanguageEN
Citations received1
References cited18

Malaria remains a major health priority in Nigeria. Among children with fever who seek care, less than a quarter gets tested for malaria, leading to inappropriate use of the recommended treatment for malaria; Artemisinin-based Combination Therapy (ACT). Here we test an innovative strategy to target ACT subsidies to clients seeking care in Nigeria’s private retail health sector who have a confirmed malaria diagnosis. We supported point-of-care malaria testing (mRDTs) in 48 Private Medicine Retailers (PMRs) in the city of Lagos, Nigeria and randomized them to two study arms; a control arm offering subsidized mRDT testing for USD $0.66, and an intervention arm where, in addition to access to subsidized testing as in the control arm, clients who received a positive mRDT at the PMR were eligible for a free (fully subsidized) first-line ACT and PMRs received USD $0.2 for every mRDT performed. Our primary outcome was the proportion of ACTs dispensed to individuals with a positive diagnostic test. Secondary outcomes included proportion of clients who were tested at the PMR and adherence to diagnostic test results. Overall, 23% of clients chose to test at the PMR. Test results seemed to inform treatment decisions and resulted in enhanced targeting of ACTs to confirmed malaria cases with only 26% of test-negative clients purchasing an ACT compared to 58% of untested clients. However, the intervention did not offer further improvements, compared to the control arm, in testing rates or dispensing of ACTs to test-positive clients. We found that ACT subsidies were not passed on to clients testing positive in the intervention arm. We conclude that mRDTs could reduce ACT overconsumption in Nigeria’s private retail health sector, but PMR-oriented incentive structures are difficult to implement and may need to be complemented with interventions targeting clients of PMRs to increase test uptake and adherence. Trials registration: Clinical Trials Registration Number: NCT04428307 . https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816435/ Correction: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9476591

Business · Economic growth · Environmental health · Family medicine · Health care · Incentive · Malaria · Psychological intervention · Randomized controlled trial · Rapid diagnostic test · Subsidy · Global Maternal and Child Health · Malaria Research and Control · Medicine · Mosquito-borne diseases and control · Nursing · Surgery