Tag: TESTsmART

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TESTsmART Team Training

17-18 February 2020

Eldoret, Kenya

The TESTsmART Team is used to meeting virtually, and had mastered the art of Zoom meetings before it became the modus operandi of the post-COVID world. Team members are physically based in the USA (from Durham, NC to San Francisco, CA), Kenya, Nigeria, and Uganda, but every Wednesday, the entire team logs onto Zoom to meet and discuss the study. Team members provide status updates, review monitoring and evaluation reports, and collaborate on solutions to operational challenges.

Right before the COVID-19 pandemic hit and life as the world knew it was severely interrupted, the TESTsmART study team snuck in one last in-person meeting to prepare for the launch of Aim 2 of our study.

After months of hard work and preparation for the study launch (which included developing the study protocol , designing the data collection tools, obtaining ethics approval from 3 different institutional review boards (IRBs), and conducting baseline surveys at potential retail outlets, writing standard operating procedures for every aspect of study implementation), the international team decided to officially kickoff Aim 2 by convening together in Eldoret, Kenya for a two day, in-person training.

The TESTsmART Team member who attended the team training in Eldoret

Day 1 kicked off with a study overview and review of the 12 study standard operating procedures (SOPs).  Team members took turns presenting and were quizzed on their knowledge of the protocol and all the SOPs in a high stakes challenge between the Duke-Kenya and CHAI-Nigeria study teams. Up for grabs was bragging rights and the study mascot, affectionately known as the TESTsmART Teddy. At the end of the day, Kenya team prevailed!

Day 2 started early with the entire team traveling out to the field site in Webuye, about 2 hrs from the Eldoret office. The team met the Field Researchers at the home base at PEARL, and discussed the next stages of the launch focused on the retail outlets including enrollment, training, and arm randomization. The teams split up into smaller groups to go out and gain firsthand experiences at retail outlets in the area. In the afternoon, the team members reconvened to debrief about their observations from the day and chart timelines and next steps for rolling out the study intervention.

Everyone left feeling energized and excited for the launch of the project that they had been working so hard to prepare for.

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New grant to improve targeting of subsidized antimalarials sold over-the-counter

This month, we received a new award from the National Institute of Allergy and Infectious Diseases (NIH) to study interventional approaches to improve the targeting of artemisinin combination therapy to individuals with confirmed malaria infection. This new project builds on our previous work to target antimalarials through a partnership between community health workers and private medicine retailers.

In 2016, the WHO estimated that 216 million cases of malaria occurred worldwide, yet more than 400 million treatment courses of first-line antimalarials (artemisinin combination therapy or ACT) were consumed.  This substantial overuse of ACTs is driven in large part by the private retail sector. More than half of families in sub-Saharan Africa seek treatment for febrile illness in retail medicine outlets where ACT is available over-the-counter, but malaria diagnostic testing is virtually absent and presumptive treatment of fever as malaria is the norm. Availability of inexpensive, donor-subsidized ACTs and the absence of diagnostic testing lead to very poor targeting of ACTs to people who need them. Individuals without malaria consume between 65-90% of ACTs distributed through retail outlets. Unnecessary consumption of ACTs is a drain on scarce public health resources and threatens the future sustainability of publicly-funded subsidies.

Although accurate point of care diagnostics are available for malaria (called rapid diagnostic tests or RDTs), they are uncommon in the retail sector and, where they have been tried, their impact on appropriate ACT use is often poor. We hypothesize that both providers and clients’ decisions about testing and treatment are strongly influenced by price (or profit). In response to this, we will test a scalable, policy-relevant strategy that integrates testing and treatment subsidies for the client, with incentives to the provider to test for malaria. ACT subsidies will be available only to customers with a positive malaria test (conditional ACT subsidy). Differential ACT pricing for clients based on the results of the diagnostic test, combined with provider rewards for testing, will align both consumers and providers incentives (price and profit) with testing and appropriate ACT use. Our approach will ensure that public subsidies are directed to confirmed malaria cases thereby enhancing the sustainability of such programs. By allocating subsidy dollars across both testing and conditional treatment (rather than universal, treatment-only subsidies), we can reduce the cost of subsidizing malaria treatment and improve targeting of ACTs without compromising access.

This work will be carried out in Kenya and Nigeria in collaboration with Clinton Health Access Initiative.

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