Assessing the independent and combined effects of subsidies for antimalarials and rapid diagnostic testing on fever management decisions in the retail sector: results from a factorial randomised trial in western Kenya.

摘要: Objectives There is an urgent need to understand how improve targeting of artemisinin combination therapy (ACT) patients with confirmed malaria infection, including subsidised ACTs sold over-the-counter. We hypothesised that offering antimalarial subsidy conditional on a positive rapid diagnostic test (RDT) would increase uptake testing and rational use ACTs. Methods designed 2×2 factorial randomised experiment evaluating 2 levels for RDTs Between July 2014 June 2015, 444 individuals malaria-like illness who had not sought treatment were recruited from their homes. used scratch cards allocate participants into 4 groups in ratio 1:1:1:1. Participants eligible unsubsidised or fully RDT 1 ACT (current retail price additional RDT). Treatment decisions documented 1 week later. Our primary outcome was testing. Secondary outcomes evaluated consumption among those negative test, no test. Results Offering free increased the probability by 18.6 percentage points (adjusted difference (APD), 95% CI 5.9 31.3). An offer did have effect when (APD=2.7; −8.6 14.1). However, receiving taking following 19.5 (APD, 2.2 36.8). Overall, proportion took lower than without being tested, indicated improved tested. Conclusions Both subsidies appropriate fever management, demonstrating impact these costs decision making. conclude each primarily impacts most immediate decision. Trial registration number NCT02199977.