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London School of Hygiene & Tropical Medicine Malaria Centre

Malaria research in social and economic studies

IMPACT2: monitoring interventions to improve ACT access and targeting.

LSHTM investigators:
Catherine Goodman, Katia Bruxvoort, Rebecca Thomson, Harparkash Kaur & Matt Cairns
External collaborators:
Salim Abdulla, Admirabilis Kalolella, Emmy Metta, Charles Festo, Boniface Johannes, Happy Nchimbi & Clarence Mkoba (Ifakara Health Institute, Tanzania); Patrick Kachur, Julie Thwing, Denise Roth Allen & Melissa Briggs (Centers for Disease Control and Prevention, USA).
Funding body:
he Bill & Melinda Gates Foundation through the ACT Consortium.

While a general consensus over the choice of ACT as the future malaria therapy has developed, a solid evidence-base for choosing the best ACT deployment strategies to gain optimal impact on malaria morbidity and mortality does not exist.

Countries are now beginning to adopt policies to enhance ACT deployment but face tension between the twin goals of: (i) making ACTs more readily and speedily accessible to patients, or (ii) targeting ACTs to patients shown to have malaria parasitaemia.

The Tanzanian Government has secured funding to address ACT access and targeting on a national scale. Access is being improved through the distribution of subsidised ACT through private facilities and Accredited Drug Dispensing Outlets (ADDOs) under the Affordable Medicines Facility-malaria (AMFm). Targeting is being addressed through enhancing microscopy and expanding RDTs to health facilities at every level of the system.  This study aims to evaluate these interventions through a pre-post plausibility evaluation in selected regions (Mwanza, Mtwara, Mbeya). The study forms part of the programme or work of the ACT Consortium.

The key objective is to assess the effectiveness of the introduction of RDTs in health facilities, and subsidized ACT in the private sector in terms of coverage, equity, quality, adherence and public health impact, and to explore the socio-cultural context and other factors that influence the implementation and outcome of the interventions. Data collection methods include surveys of households, health facilities and drug shops, studies of adherence and parasitaemia prevalence at health facilities and drug shops and qualitative methods.