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