Can Research Address Bottlenecks in ACT Delivery?

The ACT Consortium is in the process of addressing four key issues in ACT delivery through research projects in 9 countries with around 21 partner institutions according to a symposium Thursday at the MIM 5th Pan-African Malaria Conference. The Consortium had a long gestation period with the idea being floated around 2001 and final funding securred in 2007.

many-artemisinin-based-drugs-are-available.jpgDuring that gestation period millions of doses of ACTs have been delivered, and is universal coverage is to be achieved in 2010, millions more doses will have to be provided next year and beyond. Research results from the consortium may not come online for a few more years, and we hope that the findings will be relevant for sustaining treatment during the crucial years between scale-up and pre-elimination.

The four key areas for research into how to improve access to appropriate, high quality medicines are as follows:

  1. Access – including equity issues
  2. Targeting – with a focus on improved diagnostics, cost-effectiveness and supply management
  3. Safety – drugs are licensed after trials on only 6,000 people, so surveillance for rare adverse events is needed as well as interactions with other medications (e.g. for HIV)
  4. Quality – addressing substandard, fake/counterfeit, and degraded (through transport, storage) medicines

Panelists shared their research plans which included, for example, the possible effects of RDT use on rational prescribing. There is also interest in finding out what prescribers do when RDT results are negative, which depends on having treatment for alternative causes of fever.

There is a strong social science component that will explore provider and user perceptions and the determinants of the decisions they make to prescribe medicines and use them.  In Ghana the studies will have important economic implications for their national health insurance scheme.

In Tanzania where ACT access among children was said to be only 14% at present, the research is addressing the private sector and may tie in with the greatly anticipated AMFm grant. Tanzania is trying to scale up efforts at improving the quality of private sector medicine shops through training and franchising in Accredited Drug Dispensing Outlets – the ADDO shops. A Herculean effort to bring 10,000 new shops on board will be aided by research in at least 3 provinces.

Answers to many ACT access questions are needed now. We happily await the results of the ACT Consortium’s efforts. In the meantime countries should also use the operation research funding available through their Global Fund and soon to be deployed AMFm grants to answer more immediate delivery and bottleneck questions. Basic procurement, supply and use monitoring will also go a long way to inform our efforts to guarantee appropriate universal coverage of ACTs.

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