On June 29, 2010 the Center for Global Development hosted a lively discussion led by Jessica Cohen, Harvard School of Public Health and Brookings Institution, on the implications of increased access to Rapid Diagnostic Tests (RDTs) on malaria treatment (in the form of Artemisinin Combination Therapies, or ACTs) uptake in western Kenya. In a presentation of a recent study entitled Diagnostic Tests and Demand for Malaria Control: Evidence from a Randomized Control Trial, Cohen began by highlighting existing challenges to malaria control, including limited treatment options, high costs of medication, lack of human resources in the drug retail sector, and the spread of anti-malarial resistance due to overtreatment. She went on to explore the effect of subsidized RDT on the tendency for individuals to purchase ACTs (in other words, whether or not having a clear diagnosis increases the likelihood that a customer will go on to purchase malarial treatment), and the capacity for RDTs to effectively target malaria-positive individuals. Cohen revealed several key findings, including the fact that less than 40 percent of individuals over age 9 for whom subsidized ACTs are purchased actually test positive for malaria (implying that subsidies for treatment may increase inappropriate use of treatment and potentially increase the likelihood of resistance), and that while reducing the price of ACT increases utilization of the drug, it also reduces the proportion of malaria-positive individuals among ACT users. Cohen and her colleagues also found that although willingness to utilize RTDs was generally high in this study, RDT results were not a significant predictor of subsequent uptake of treatment, as the majority (60 percent) of RDT-negative patients decided to purchase ACTs despite their diagnosis. Of great interest, Cohen explained, is the need to understand why a negative RDT result failed to discourage patients from purchasing treatment—and is a topic for further research.
The event was moderated by CGD senior fellow Mead Over. Discussant Rachel Nugent, CGD’s deputy director of global health and chair of the Drug Resistance Working Group, highlighted the importance of understanding how increased access to RDTs can be accompanied by efforts to improve adherence to RDT diagnostics, as well as changes to provider and patient behavior, to reduce waste and the likelihood of mistreatment.
Access Cohen's slides (pdf, 798K).
Access Cohen's paper (pdf, 634K).