UNITAID Private Sector RDT Project A partnership between FIND, JHUSPH, MC, PSI and the WHO funded by UNITAID Background – Current challenges of malaria RDT use in the private sector The World Health Organization (WHO) recommends that every suspected malaria case be confirmed by parasitological testing using microscopy or Rapid Diagnostic Tests (RDTs) and that uncomplicated P. falciparum malaria be treated with artemisinin-‐based combination therapy (ACT).1 The availability of high-‐quality, inexpensive RDTs in the public sector has significantly improved and expanded diagnostic testing. However, in the private sector, where a large proportion -‐ over 40% -‐ of the population in endemic countries seeks care and treatment for febrile illness,2,3 RDTs are either non-‐existent or more expensive than ACT. 4 As a result, febrile illness is presumptively treated with ACT, leading to mistreatment of potentially life-‐threatening non-‐malaria febrile illnesses and to the overuse of ACTs. Project objectives – Stimulating a private sector market for malaria RDTs The UNITAID Private Sector RDT Project aims to stimulate the creation of a private sector market for malaria RDTs, by (i) increasing both access to and demand for quality-‐assured RDTs, (ii) improving private providers’ fever case management skills and (iii) developing and implementing a roadmap for public-‐private engagement that will guide policy and regulation. The project will be implemented in five target countries: Kenya, Madagascar, Nigeria, Tanzania (mainland) and Uganda. Expected impact and outcomes By scaling-‐up access to affordable, quality-‐assured RDTs offered by trained and supervised providers incentivized to correctly manage febrile UNITAID illness, the project will contribute to reducing delays in the management Private Sector RDT Project of febrile illness, and to promoting treatment adherence. In addition, by countries reducing overtreatment with ACT, the project will help to improve the rational use of antimalarials. The documented learning gained from the project will feed into policy recommendations, guidance and advocacy documents that will inform the rollout of similar initiatives across other malaria endemic countries. Project partners and roles The project is led by Population Services International (PSI), together with its collaborating implementers, Foundation for Innovative New Diagnostics (FIND), Malaria Consortium (MC) and the World Health Organization (WHO). PSI will implement the project in Kenya, Madagascar and Tanzania by working directly with private outlets, while MC in Nigeria and Uganda will use a more indirect approach by working through the manufacturers to reach the outlets. FIND and WHO will provide support to all country programs for quality assurance of RDTs and guidance on regulations and policy. Finally, FIND will work with the Johns Hopkins University School of Public Health (JHUSPH) to provide input on training materials, job aids and tools for supervising providers’ proficiency, as well as conduct a semi-‐independent project evaluation. The approaches will be modified to fit the local context. Contact For specific country information please contact, Stephanie Dolan, Deputy Project Director [email protected] (Kenya, Madagascar, Tanzania) and Grace Nakawangi, [email protected] (Uganda, Nigeria) 1 WHO Guidelines for the treatment of malaria -‐-‐ 2nd edition, Geneva 2010. 2 Cibulskis RE, Aregawi M, Williams R, Otten M, Dye C (2011) Worldwide Incidence of Malaria in 2009: Estimates, Time Trends, and a Critique of Methods. PLoS Med 8(12): e1001142. doi:10.1371/journal.pmed.1001142 3 Littrell M et al.: Monitoring fever treatment behaviour and equitable access to effective medicines in the context of initiatives to improve ACT access: baseline results and implications for programming in six African countries. Malaria Journal 2011 10:327. 4 Albertini A et al. :Preliminary enquiry into the availability, price and quality of malaria rapid diagnostic tests in the private health sector of six malaria-‐endemic countries. Trop Med Int Health 2012 Feb;17(2):147-‐52