Background: There is considerable interest in the potential of private sector subsidies to increase availability and\r\naffordability of artemisinin-based combination therapies (ACTs) for malaria treatment. A cluster randomized trial of such\r\nsubsidies was conducted in 3 districts in Kenya, comprising provision of subsidized packs of paediatric ACT to retail outlets,\r\ntraining of retail staff, and community awareness activities. The results demonstrated a substantial increase in ACT\r\navailability and coverage, though patient counselling and adherence were suboptimal. We conducted a qualitative study in\r\norder to understand why these successes and limitations occurred.\r\nMethodology/Principal Findings: Eighteen focus group discussions were conducted, 9 with retailers and 9 with caregivers,\r\nto document experiences with the intervention. Respondents were positive about intervention components, praising the\r\nfocused retailer training, affordable pricing, strong promotional activities, dispensing job aids, and consumer friendly\r\npackaging, which are likely to have contributed to the positive access and coverage outcomes observed. However, many\r\nretailers still did not stock ACT, due to insufficient supplies, lack of capital and staff turnover. Advice to caregivers was poor\r\ndue to insufficient time, and poor recall of instructions. Adherence by caregivers to dosing guidelines was sub-optimal,\r\nbecause of a wish to save tablets for other episodes, doses being required at night, stopping treatment when the child felt\r\nbetter, and the number and bitter taste of the tablets. Caregivers used a number of strategies to obtain paediatric ACT for\r\nolder age groups.\r\nConclusions/Significance: This study has highlighted that important components of a successful ACT subsidy intervention\r\nare regular retailer training, affordable pricing, a reliable supply chain and community mobilization emphasizing patient\r\nadherence and when to seek further care.
Loading....