Bulletin of the World Health Organization

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