Global Health and Population Department, Harvard School of Public Health, Harvard University, Boston, Massachusetts, United States of America.
PLoS One. 2013 Jul 29;8(7):e70713. doi: 10.1371/journal.pone.0070713. Print 2013.
The Affordable Medicines Facility-malaria (AMFm) is a pilot program that uses price subsidies to increase access to Artemisinin Combination Therapies (ACTs), currently the most effective malaria treatment. Recent evidence suggests that availability and affordability of ACTs in retail sector drug shops (where many people treat malaria) has increased under the AMFm, but it is unclear whether household level ACT use has increased.
household surveys were conducted in two remote regions of Tanzania (Mtwara and Rukwa) in three waves: March 2011, December 2011 and March 2012, corresponding to 3, 13 and 16 months into the AMFm implementation respectively. Information about suspected malaria episodes including treatment location and medications taken was collected. Respondents were also asked about antimalarial preferences and perceptions about the availability of these medications. Significant increases in ACT use, preference and perceived availability were found between Rounds 1 and 3 though not for all measures between Rounds 1 and 2. ACT use among suspected malaria episodes was 51.1% in March 2011 and increased by 10.9 percentage points by Round 3 (p = .017). The greatest increase was among retail sector patients, where ACT use increased from 31% in Round 1 to 49% in Round 2 (p = .037) and to 61% (p<.0001) by Round 3. The fraction of suspected malaria episodes treated in the retail sector increased from 30.2% in Round 1 to 46.7% in Round 3 (p = .0009), mostly due to a decrease in patients who sought no treatment at all. No significant changes in public sector treatment seeking were found.
The AMFm has led to significant increases in ACT use for suspected malaria, especially in the retail sector. No evidence is found supporting the concerns that the AMFm would crowd out public sector treatment or neglect patients in remote areas and from low SES groups.
平价药品机制-疟疾（AMFm）是一个试点项目，通过价格补贴来增加青蒿素复方疗法（ACTs）的可及性，ACTs 是目前最有效的疟疾治疗方法。最近的证据表明，在 AMFm 下，零售部门药店（许多人治疗疟疾的地方）的 ACTs 的可获得性和可负担性有所提高，但尚不清楚家庭层面的 ACT 使用是否有所增加。
在坦桑尼亚的两个偏远地区（姆特瓦拉和鲁夸）进行了三次家庭调查：2011 年 3 月、2011 年 12 月和 2012 年 3 月，分别对应 AMFm 实施后的 3、13 和 16 个月。收集了有关疑似疟疾发作的信息，包括治疗地点和服用的药物。受访者还被问及对抗疟药物的偏好以及对这些药物可获得性的看法。虽然在第一轮和第二轮之间，所有措施的 ACT 使用、偏好和感知可用性都没有增加，但在第一轮和第三轮之间发现了显著增加。在疑似疟疾发作中，ACT 的使用率从 2011 年 3 月的 51.1%增加到第三轮的 61.9%（p=0.0009），涨幅为 10.9 个百分点（p=0.017）。最大的增长是在零售部门的患者中，ACT 的使用率从第一轮的 31%增加到第二轮的 49%（p=0.037），到第三轮增加到 61%（p<.0001）。在零售部门治疗的疑似疟疾发作比例从第一轮的 30.2%增加到第三轮的 46.7%（p=0.0009），这主要是因为没有寻求任何治疗的患者减少了。在公共部门寻求治疗方面没有发现显著变化。
AMFm 导致 ACT 在疑似疟疾中的使用率显著增加，特别是在零售部门。没有证据支持 AMFm 会排挤公共部门治疗或忽视偏远地区和低收入群体患者的担忧。
