Centers for Disease Control, Atlanta, GA, USA.
Trop Med Int Health. 2011 Mar;16(3):272-9. doi: 10.1111/j.1365-3156.2010.02724.x. Epub 2011 Jan 12.
To assess the degree to which policy changes to artemisinin-based combination therapies (ACTs) as first-line treatment for uncomplicated malaria translate into effective ACT delivery.
Prospective observational study of drug dispensing practices at baseline and during the 3 years following introduction of ACT with sulfadoxine-pyrimethamine (SP) plus artesunate (AS) in Rufiji District, compared with two neighbouring districts where SP monotherapy remained the first-line treatment, was carried out. Demographic and dispensing data were collected from all patients at the dispensing units of selected facilities for 1 month per quarter, documenting a total of 271, 953 patient encounters in the three districts.
In Rufiji, the proportion of patients who received a clinical diagnosis of malaria increased from 47.6% to 57.0%. A majority (75.9%) of these received SP + AS during the intervention period. Of patients who received SP + AS, 94.6% received the correct dose of both. Among patients in Rufiji who received SP, 14.2% received SP monotherapy, and among patients who received AS, 0.3% received AS monotherapy.
The uptake of SP + AS in Rufiji was rapid and sustained. Although some SP monotherapy occurred, AS monotherapy was rare, and most received the correct dose of both drugs. These results suggest that implementation of an artemisinin combination therapy, accompanied by training, job aids and assistance in stock management, can rapidly increase access to effective antimalarial treatment.
评估抗疟药青蒿素复方疗法（ACT）作为一线治疗药物的政策变化在多大程度上转化为有效的 ACT 供应。
在 Rufiji 地区，对引入磺胺多辛-乙胺嘧啶（SP）加青蒿琥酯（AS）作为一线治疗药物的前 3 年与两个邻近地区的药物配给做法进行了前瞻性观察研究，在这两个地区，SP 单一疗法仍然是一线治疗药物。在选定的设施配药单位，每个季度收集一个月的人口统计学和配药数据，共记录了三个地区的 271953 例患者就诊情况。
在 Rufiji，接受疟疾临床诊断的患者比例从 47.6%增加到 57.0%。大多数（75.9%）患者在干预期间接受了 SP + AS。在接受 SP + AS 的患者中，94.6%的患者接受了两种药物的正确剂量。在接受 SP 的 Rufiji 患者中，14.2%接受了 SP 单一疗法，而在接受 AS 的患者中，0.3%接受了 AS 单一疗法。
Rufiji 地区迅速且持续地采用了 SP + AS。尽管出现了一些 SP 单一疗法，但 AS 单一疗法很少见，大多数患者接受了两种药物的正确剂量。这些结果表明，实施青蒿素复方疗法，并辅以培训、工作辅助工具和库存管理援助，可以迅速增加获得有效抗疟治疗的机会。
