Dr. S. Patrick Kachur, Strategic and Applied Sciences, Unit Malaria Branch, US Centers for Disease Control and Prevention

Patrick Kachur has 20 years experience in applied epidemiology and social science, and their application to malaria control in Africa and Asia. He leads a multi-disciplinary team of 9 US-based investigators working on implementation research questions for malaria control and elimination. He led a pilot evaluation of ACT in Tanzania from 2000 to 2006. He is an advisor the US President's Malaria Initiative.

• Salim Abdulla, Ifakara Health Institute
• Catherine Goodman, LSHTM and KEMRI-Wellcome Trust Research Programme

Co-Investigators:

• Dr Admirabilis Kalolella, Charles Festo, Emmy Metta, Boniface Johanes, Clarence Mkoba, Happy Nchimbe, Ifakara Health Institute
• Mark Taylor, Katia Bruxvoort, Rebecca Thomson, Matt Cairns, LSHTM & Ifakara Health Institute
• Denise Allen, Julie Thwing, Eugenie Poirot, US Centers for Disease Control

Collaborators:

• Alex Mwita and Renata Mandike, National Malaria Control Program, Ministry of Health and Social Welfare
• Margareth Mdomondo, Tanzania Food and Drugs Authority
• Harparkash Kaur, LSHTM

It is generally agreed that ACT is the malaria therapy of choice, but there is much less agreement about the best ACT deployment strategies.  Countries are now beginning to adopt policies to enhance ACT deployment that aim to address 2 key goals: (i) making ACTs more readily and speedily accessible to patients, or (ii) targeting ACTs to patients shown to have malaria parasitaemia.

The Tanzanian Government has secured funding to address both ACT access and targeting on a national scale. Access is to be improved through the distribution of subsidised ACT through private facilities and retail drug shops under the Affordable Medicines Facility-malaria (AMFm). Targeting is to be addressed through enhancing microscopy and introducing rapid diagnostic test in health facilities at every level of the system. 

This study will evaluate these two interventions, in 3 rural Tanzanian regions, covering one region with early implementation of enhanced diagnosis, one with early implementation of subsidised ACT, and one without either intervention which will act as a comparator. We will assess intervention effectiveness in terms of coverage, equity, quality, adherence, and public health impact. In addition we will estimate the cost and cost-effectiveness of implementation from a health system and household perspective. Finally we will explore the socio- cultural context and other factors that influence the implementation and outcome of the interventions.

Cleaning and analysis of baseline data for IMPACT2 household, health facility and outlet surveys and qualitative data is underway. Subsidized ACTs are now available in the private sector and RDTs have been rolled out in the study regions.  Follow up data collection activities are planned for late 2011 - mid 2012.