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Visser T, Laktabai J, Kimachas E, Kipkoech J, Menya D, Arthur D, Zhou Y, Chepkwony T, Abel L, Robie E, Amunga M, Ambani G, Uhomoibhi P, Ogbulafor N, Oshinowo B, Ogunsola O, Woldeghebriel M, Garber E, Olaleye T, Eze N, Nwidae L, Mudabai P, Gallis J, Fashanu C, Saran I, Woolsey A, Turner E, Prudhomme O’Meara W. 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. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.30.24302026. [PMID: 38352390 PMCID: PMC10862997 DOI: 10.1101/2024.01.30.24302026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
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; Artemether Combination Therapies (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 RDTs 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. Clinical Trials Registration Number: NCT04428307.
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Affiliation(s)
- T. Visser
- Clinton Health Access Initiative (CHAI), Boston, Massachusetts, United States of America
| | - J. Laktabai
- Moi University School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - E. Kimachas
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - J. Kipkoech
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - D. Menya
- Moi University School of Public Health, College of Health Sciences, Moi University, Kenya
| | - D. Arthur
- Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Y. Zhou
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
| | - T. Chepkwony
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - L. Abel
- Moi University School of Public Health, College of Health Sciences, Moi University, Kenya
| | - E. Robie
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - M. Amunga
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - G. Ambani
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - P. Uhomoibhi
- National Malaria Elimination Program, Federal Ministry of Health & Social Welfare, Abuja, Nigeria
| | - N. Ogbulafor
- National Malaria Elimination Program, Federal Ministry of Health & Social Welfare, Abuja, Nigeria
| | - B. Oshinowo
- Lagos State Malaria Elimination Program, Lagos State Ministry of Health, Lagos, Nigeria
| | - O. Ogunsola
- Simon Business School, University of Rochester, Rochester, New York, United States of America
| | | | - E. Garber
- Clinton Health Access Initiative (CHAI), Abuja, Nigeria
| | - T. Olaleye
- Clinton Health Access Initiative (CHAI), Abuja, Nigeria
| | - N. Eze
- Clinton Health Access Initiative (CHAI), Abuja, Nigeria
| | - L. Nwidae
- Clinton Health Access Initiative (CHAI), Abuja, Nigeria
| | - P. Mudabai
- Clinton Health Access Initiative (CHAI), Abuja, Nigeria
| | - J.A. Gallis
- Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - C. Fashanu
- Clinton Health Access Initiative (CHAI), Abuja, Nigeria
| | - I. Saran
- School of Social Work, Boston College, Massachusetts, United States of America
| | - A. Woolsey
- Clinton Health Access Initiative (CHAI), Boston, Massachusetts, United States of America
| | - E.L. Turner
- Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - W. Prudhomme O’Meara
- Duke Global Health Institute and Moi University School of Public Health, College of Health Science
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Rotimi K, Fagbemi B, Itiola AJ, Ibinaiye T, Aidenagbon A, Dabes C, Biambo AA, Iwegbu A, Onabajo S, Oguoma C, Oresanya O. Private sector availability and affordability of under 5 malaria health commodities in selected states in Nigeria and the Federal Capital Territory. J Pharm Policy Pract 2023; 17:2294024. [PMID: 38223355 PMCID: PMC10783550 DOI: 10.1080/20523211.2023.2294024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background To guarantee uninterrupted service delivery, quality-assured products must be affordable and continuously available across all sectors, including the private sector, which provides more than 60% of healthcare services in Nigeria. We investigated the private sector availability and affordability of under 5 malaria commodities to establish the level of access in this sector. Methods We surveyed patent medicine and pharmacy stores across seven states in Nigeria and the Federal Capital Territory to establish the availability and affordability of selected malaria commodities for children under 5 years. Availability was measured as the percentage of visited outlets with the product of interest on the day of visit, while affordability was assessed by establishing if it cost more than a day's wage for the least-paid government worker to purchase a full course of malaria diagnostic test and/or medication. Results Artemisinin-based antimalarials for uncomplicated and severe malaria were the most available commodities. SPAQ1 and SPAQ2 used for seasonal malaria chemoprevention campaign were surprisingly also available in some outlets. However, only about half (48.3% and 53.3%) of the surveyed outlets had stock of artemether/lumefantrine (AL1) and artesunate injection, respectively. The median price of surveyed products ranged from USD (United States Dollars) 0.38 to USD 2.17 per treatment/test. Except for amodiaquine tablet and artemether injection, which cost less, all other originator brands cost the same or more than the lowest-priced generic. Antimalarial products were affordable as their median prices were not more than a day's wage for the least-paid government worker. However, when the cost of testing and treatment with artemisinin-based combination therapies (ACTs) was assessed, testing and treatment with dihydroartemisinin/piperaquine were unaffordable as the they cost more than 1.5 times the daily wage of the least-paid government worker. Conclusion The overall private sector availability of under-five malaria commodities in surveyed locations was suboptimal. Also, testing and treatment with recommended ACTs were not affordable for all surveyed products. These findings suggest the need for interventions to improve access to affordable under-five malaria commodities.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sarah Onabajo
- National Agency for Food and Drug Administration and Control, Lagos, Nigeria
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Aizobu D, Idogho O, Anyanti J, Omoregie G, Adesina B, Kabeer M, Oyegunle S, Malaba S, Ikpeazu A, Wada YH. Stakeholders' perception of a total market approach to HIV self-testing (HIVST) for the private sector in Nigeria. BMC Public Health 2023; 23:550. [PMID: 36959586 PMCID: PMC10034893 DOI: 10.1186/s12889-023-15352-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/01/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND The continuous supply of affordable and quality HIV self-test (HIVST) is a key pillar toward achieving the global HIV 95-95-95 target in Nigeria. This was a descriptive qualitative study that explored private sector stakeholders' perceptions of the enablers and barriers of the HIVST market in Nigeria. METHODS A total of 29 In-depth interviews (IDIs) were conducted with HIVST supply chain stakeholders and private sector providers (PPMVs and Community Pharmacies). Responses were analyzed using Nvivo software and we systematically developed a total market approach analysis for supply chain stakeholders and archetypes for community Pharmacies and PPMVs based on insights gathered from their journey map. RESULTS Challenges to the supply side dynamics include forecasting, point of care service delivery, the availability of free and subsidized HIVST kits in the market, neglect of private sector providers (Community Pharmacists and PPMVs) in the healthcare delivery system, limited demand for HIVST, and regulatory bottlenecks influences the overall market dynamics. High cost of the HIVST kit, which triggers low availability, accessibility and affordability from the demand side, depicts the need to understand the market dynamics. Addressing the barriers and optimizing the enablers of the three-model pharmacist and PPMV's will change the market dynamic and service delivery to generate demand. CONCLUSION To address challenges which already exist, the government need to revise the process guidelines for introducing new HIVST products in the Nigerian market, developing contingency plans to ensure the supply of HIVST remains sufficient when experiencing economic shocks, and create a sustainable roadmap toward optimizing the market for HIVST kits.
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Affiliation(s)
| | | | | | | | | | - Morgan Kabeer
- Busara Center for Behavioral Economics, Abuja, Nigeria
| | | | - Serah Malaba
- Population Services International, Nairobi, Kenya
| | - Akudo Ikpeazu
- National AIDS/STIs Control Programme, Abuja, Nigeria
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