Chepkwony Tabitha, Amunga Mark E, Kimachas Emmah, Kipkoech Joseph, Robie Emily, Wekesa Aggrey, Arthur David, Turner Elizabeth L, Gallis John A, Abel Lucy, Ambani George, Visser Theodoor, Woldeghebriel Meley, Babur Sameen, Woolsey Aaron, Menya Diana, Laktabai Jeremiah, O'Meara Wendy P
AMPATH.
Duke University NC.
Res Sq. 2024 Oct 21:rs.3.rs-5005686. doi: 10.21203/rs.3.rs-5005686/v1.
In malaria-endemic countries, private retail outlets are a major source of antimalarials for individuals experiencing an acute febrile illness. However, there remains a challenge in how the decision to dispense the drugs is made. The lack of malaria diagnostic tools in the retail sector leads to a presumptive approach to diagnosis and overuse of ACTs. The TESTsmART study trained retail outlet attendants to perform malaria rapid diagnostic tests (mRDTs) in conjunction with a mobile application to capture testing and drug dispensing data. Concurrently, febrile clients were randomly selected for exit interviews outside the outlet, and analogous information about testing and drug purchasing was recorded based on self-report. A small subset of clients enrolled in exit interviews were also asked to participate in exit mRDT testing to confirm the accuracy of mRDTs in the outlet and to estimate malaria positivity amongst untested clients. In this sub-study, comparison of these two concurrent data sources showed the testing rate for eligible participants was slightly lower in the exit interview (42.8%, 2436/5695) than in the app (51.1%, 24,446/49,804). We noted important differences in the experiences of testing and adherence reported by outlets compared to clients; 11.0% of clients had positive mRDT reported in the app (and validated by photo review) compared to 35.3% from exit interviews. Outlets reported that 97% of test-positive clients received a first-line Artemether Combination Therapy (ACT), but only 77% of clients who reported a positive test also reported receiving the first-line ACT in the exit interview. For test-negative clients, 35% received an ACT based on outlet reports compared to 25% by exit interviews. Among 109 clients randomly selected for re-test at exit interview, nearly two-thirds of those who reported a positive test from the outlet had a negative mRDT (64.3%, 9/14) when retested. Contrasting outcomes reported by the provider and the client highlight barriers to improving testing and adherence for malaria as well as challenges for monitoring case management in the retail sector. These include accurate communication of results to the client, poor confidence in a negative result, and reluctance to withhold antimalarials from test-negative clients.
在疟疾流行国家，私人零售药店是急性发热患者抗疟药的主要来源。然而，在如何决定配药方面仍然存在挑战。零售部门缺乏疟疾诊断工具导致采用推定诊断方法和过度使用青蒿素联合疗法（ACT）。TESTsmART研究培训零售药店工作人员结合移动应用程序进行疟疾快速诊断测试（mRDT），以获取检测和药品配给数据。同时，随机选择发热患者在药店外进行出院访谈，并根据自我报告记录有关检测和购药的类似信息。还要求一小部分参与出院访谈的患者参加出院时的mRDT检测，以确认药店中mRDT的准确性，并估计未检测患者中的疟疾阳性率。在这项子研究中，对这两个并行数据源的比较显示，符合条件的参与者在出院访谈中的检测率（42.8%，2436/5695）略低于应用程序中的检测率（51.1%，24446/49804）。我们注意到药店报告的检测和依从性体验与患者报告的存在重要差异；应用程序中报告mRDT呈阳性（并经照片审核验证）的患者为11.0%，而出院访谈中的这一比例为35.3%。药店报告称，97%检测呈阳性的患者接受了一线蒿甲醚联合疗法（ACT），但在出院访谈中，只有77%报告检测呈阳性的患者也报告接受了一线ACT。对于检测呈阴性的患者，根据药店报告，35%的患者接受了ACT，而出院访谈中的这一比例为25%。在出院访谈中随机选择重新检测的109名患者中，近三分之二在药店报告检测呈阳性的患者重新检测时mRDT呈阴性（64.3%，9/14）。提供者和患者报告的不同结果凸显了改善疟疾检测和依从性的障碍以及零售部门病例管理监测的挑战。这些障碍包括向患者准确传达检测结果、对阴性结果信心不足以及不愿不给检测呈阴性的患者开抗疟药。
