Piloting the Affordable Medicines Facility-malaria: what will success look like?
Gavin Yamey, Marco Schäferhoff & Dominic Montagu
Volume 90, Number 6, June 2012, 452-460
Table 1. Subnational pilots of subsidized artemisinin-based combination therapies
|Country||Lead organization||Time frame||Design||Scale||Age group||Outlets||Change in ACT use at 1 year||ACT price at 1 year||ACT availability at 1 year||ACT market share at 1 year|
|Angola||Government, Mentor initiative||Ongoing||Uncontrolled||2 municipalities (95 pharmacies)||Children aged less than 5 years||Pharmacies||Usage data not reported||Pharmacies in intervention municipalities mostly kept to proposed price of US$ 1 for child ACTs. Price was comparable to CQ and AQ.||69% Coartem B6 (smallest packet by weight); 81% Coartem B12 (next largest packet size) 0% at baseline||38% (0% at baseline)|
|Kenya||Government, PSI, LSHTM, KEMRI||1 year (ended May 2010)||Cluster randomized controlled trial||3 districts (all in 1 province), 18 clusters (6 in each district)||Children aged less than 5 years||Retail outlets||Intervention arm: 40.2% increase from baseline.
Control arm: 14.6% increase
|95% of caregivers in the intervention arm bought subsidized ACTs at RRP of US$ 0.25||Not measured||Not measured|
|Uganda||Government, MMV||Ongoing (began in September 2008); results at 12 and 20 months are available||Non-randomized, controlled||4 intervention districts, 1 control district||All age groups||Drug shops, clinics||Intervention arm: use within 24 and 48 hours of fever onset: 15% and 20%, respectively (3% and 4%, respectively, at baseline); increase in usage was greater in control arm.||Intervention arm: 95% of people purchasing “ACT-leaf” (subsidized ACTs) paid the correct price||Intervention arm: 75% (child ACT); no baseline data available||Intervention arm: 51% (0% at baseline)|
|United Republic of Tanzania||Government, CHAI||1 year (ended November 2008)||Quasi-randomized trial||2 intervention districts, 1 control district||All age groups||Drug shops||Usage data not reported||Mean consumer price for ACTs: US$ 0.58, close to mean RRP (US$ 0.50); average price for adult ACTs not significantly different from price of SP (US$ 0.67), but significantly higher than price of AQ (US$ 0.48); mean price for child ACTs significantly less than SP (US$ 0.51) and AQ (US$ 0.86)||Intervention districts: 72.2% [mean of all age groups]; (0% at baseline). Control district: 1% (0% at baseline)||44.2% (1% at baseline) Control district: 6% (0% at baseline)|
ACTs, artemisinin-based combination therapies; AQ, amodiaquine; CQ, chloroquine; CHAI, Clinton Health Access Initiative; KEMRI, Kenya Medical Research Institute; LSHTM, London School of Hygiene and Tropical Medicine; MMV, Medicines for Malaria Venture; PSI, Population Services International; RRP, recommended retail price; SP, sulfadoxine-pyrimethamine