Why ACTs aren’t reaching those most in need
from Patrick Adams, TropIKA.net:
Almost five years after artemisinin combination therapy (ACT) became the WHO-recommended frontline treatment for malaria, the drug is still not reaching the populations most at risk of infection, according to new data released by ACTWatch, a research project led by Population Services International (PSI) in collaboration with the London School of Hygiene and Tropical Medicine (LSTM).
The results were announced today at MIM by Dr. Kathryn O’Connell, Principal Investigator of ACTwatch.
Funded by a $10 million grant to PSI from the Bill & Melinda Gates Foundation, the 5-year study was conducted across 6 sub-Saharan African countries and Cambodia. Overall, researchers surveyed availability, price, volume and use of 23,000 antimalarial drugs sourced from 20,000 outlets. What they found reveals striking differences in drug price, ACT availability as low as 20% in public sector health facilities, and a market share dominated by ineffective monotherapies.
The data confirm that a high price remains the greatest barrier to access for the poor in Africa. “A full course of an adult treatment of ACT can cost up to 65 times the minimum daily wage,” said Dr. Desmond Chavasse, Vice President of Malaria Control and Child Survival at PSI. “That’s an overpowering incentive for a consumer to make the wrong antimalarial choice.”
Despite a WHO call to ban artemesinin monotherapies, these drugs continue to permeate private sector markets in key countries such as the Democratic Republic of the Congo and Nigeria. In the latter, 95% of all antimalarials are delivered through the private sector, and the two countries together account for roughly 30% of the total sub-Saharan Africa malaria-related disease burden.
In Cambodia, where a PSI-supported subsidy has significantly reduced the price of ACTs, the most effective antimalarials are sold at about $1.20. Although close to 6 times the cost of ineffective monotherapies, the reduction is a significant improvement when compared to the other countries. And some 60% of all antimalarials sold to patients in Cambodia are the more effective artemisinin combination therapies.
Price isn’t the only barrier to access however. “The operation of the distribution chain has a major influence on which antimalarials are available to retailers,” says Dr. Kara Hanson of the London School of Hygiene & Tropical Medicine. “Influencing practices of providers near the top of the chain may be the most cost-effective way to change outcomes in this market.”
ACTwatch is intended to serve as a barometer of success for global interventions aimed at reducing the price and increasing the availability of the most effective antimalarials, including global financing mechanisms such as the Affordable Medicines Facility for malaria (AMFm).