Increase community awareness of
RDTs as a reliable method of diagnosing malaria and of their availability in
registered drug stores in Kampala
Increase the percentage of
fevers diagnosed by mRDTs in the private sector in Kampala
The programme will aim to work in
collaboration with the Ugandan government to ensure the possibility of
long-term continuation 18. A temporary regulatory waiver will need to be acquired to permit
the sale of mRDTs in the private sector16,18. This intervention does not include a plan for immediate policy
change however we hope to gather sufficient evidence to support a change in the
Given that nearly all malarial episodes in
Kampala are caused by Plasmodium falciparum,
the RDT chosen for use in the programme is the CareStart™
Malaria HRP2(Pf) antigen detecting device 18,27. The test sensitivity, stability
and ease of use have all been considered when choosing which test to use and
all production lots will be tested to ensure good procurement practice16,27. The recommended
retail price will be USD $0.40, this is set in reference to the cost of
subsidised ACTs using data from previous trials18,25,28.
Licensed drug shops in Kampala must fulfil minimum requirements and are inspected
periodically by the District Assistant Drug Inspector (DADI) for the renewal of
their license 15. This makes these
stores particularly suitable for the control intervention. In an initial planning period, they will be
mapped using GIS and data will be collected on the numbers of febrile patients currently
seeking treatment within them. This will both allow the quantification of the volume
of RDTs required and give baseline figures from which to compare the outcomes
of the intervention to.
The drug store vendors (DSVs) will then be
invited to attend a compulsory training scheme to qualify for selling the subsidised
RDTs in their stores. The training will be carried out by senior project staff
and the district health coordinator and last for two days. This is a compromise
between the time required to deliver comprehensive training and the time that
DSVs will be willing to sacrifice, given that these are days that they will be
unable to work 11,23,24,29,30. The training will be based on guidelines from the WHO 31 and UNITAID 18 and include:
Recognising signs and symptoms
How to safely perform an RDT. The
use of gloves, single use lancets and the proper disposal of hazardous waste
material. Risks associated with unsafe use of the tests could include
transmission of blood borne diseases including HIV and hepatitis 14.
How to correctly store RDTs.
Stock management and record
How to accurately read the
results of an RDT. The inability to correctly interpret the RDT could result in
inappropriate management of fever and lead to fatalities.
How to deal with RDT negative
patients. It has been shown that there is a lack of clarity relating to what
steps to take when an RDT is negative. This, coupled with pressure from the
customer for treatment, has resulted in an increase in antibiotic prescriptions
in some regions where RDTs have been implemented 8,13,29,32. Appropriate training on management of fevers and a referral system
to public health care facilities is necessary.
The training will be interactive, making
use of small group work and role-play demonstrating client interactions 15. Detailed flow charts with pictorial aids demonstrating the
appropriate course of action for positive and negative test results will also be
distributed to each store owner 23 and e-learning materials made available for future reference 18. The DSV who completed the training will be responsible for
training their employees. After the completion of this training, the store will
be accredited with an official certificate from the Ministry of Health supporting
the sale of the RDTs. In this way, the public will be aware of which drug
stores offer diagnosis and will be able to trust that they have had appropriate
training in carrying out the tests 33.
Following the distribution of the RDTs and
the commencement of sales, it is imperative that regular supervisory visits are
carried out to ensure their correct use and subsequent case management 1,8,11,15,23,24. These visits will be carried out by project staff monthly for the
first six months and will then be scaled back.
It has been shown that the introduction of
RDTs must be accompanied by social mobilisation to increase community awareness
of the tests and improve their acceptability 15,22,30,33. This will include posters, leaflets, roadside signage and community
sensitisation via meetings and church gatherings.