title: Piloting the global subsidy: the impact of subsidized artemisinin-based combination therapies distributed through private drug shops in rural Tanzania.
abstract: BACKGROUND
  WHO estimates that only 3% of fever patients use recommended artemisinin-based combination therapies (ACTs), partly reflecting their high prices in the retail sector from where many patients seek treatment. To overcome this challenge, a global ACT subsidy has been proposed. We tested this proposal through a pilot program in rural Tanzania.
  
  
  RESULTS
  Three districts were assigned to serve either as a control or to receive the subsidy plus a package of supporting interventions. From October 2007, ACTs were sold at a 90% subsidy through the normal private supply chain to intervention district drug shops. Data were collected at baseline and during intervention using interviews with drug shop customers, retail audits, mystery shoppers, and audits of public and NGO facilities. The proportion of consumers in the intervention districts purchasing ACTs rose from 1% at baseline to 44.2% one year later (p<0.001), and was significantly higher among consumers purchasing for children under 5 than for adults (p = 0.005). No change in ACT usage was observed in the control district. Consumers paid a mean price of $0.58 for ACTs, which did not differ significantly from the price paid for sulphadoxine-pyrimethamine, the most common alternative. Drug shops in population centers were significantly more likely to stock ACTs than those in more remote areas (p<0.001).
  
  
  CONCLUSIONS
  A subsidy introduced at the top of the private sector supply chain can significantly increase usage of ACTs and reduce their retail price to the level of common monotherapies. Additional interventions may be needed to ensure access to ACTs in remote areas and for poorer individuals who appear to seek treatment at drug shops less frequently.
  
  
  BACKGROUND
  Controlled-Trials.com ISRCTN39125414.
authors.affiliation: Malaria Control Team, Clinton Foundation HIV/AIDS Initiative, Boston, Massachusetts, USA. osabot@clintonfoundation.org
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Sabot
authors.forename: Alex
authors.initials: A
authors.lastname: Mwita
authors.forename: Justin M
authors.initials: JM
authors.lastname: Cohen
authors.forename: Yahya
authors.initials: Y
authors.lastname: Ipuge
authors.forename: Megumi
authors.initials: M
authors.lastname: Gordon
authors.forename: David
authors.initials: D
authors.lastname: Bishop
authors.forename: Moses
authors.initials: M
authors.lastname: Odhiambo
authors.forename: Lorrayne
authors.initials: L
authors.lastname: Ward
authors.forename: Catherine
authors.initials: C
authors.lastname: Goodman
mesh_terms: D000962:Antimalarials / Q000191:economics / Q000600:supply & distribution*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000191:economics / Q000600:supply & distribution*; D003132:Commerce / Q000379:methods; D004338:Drug Combinations; D016527:Drug Costs; D004983:Ethanolamines / Q000191:economics / Q000600:supply & distribution; D005380:Financing, Government; D005449:Fluorenes / Q000191:economics / Q000600:supply & distribution; D006297:Health Services Accessibility; D006801:Humans; D008288:Malaria / Q000517:prevention & control; D010865:Pilot Projects; D017149:Private Sector / Q000458:organization & administration; D011739:Pyrimethamine / Q000191:economics / Q000600:supply & distribution; D012423:Rural Health / Q000706:statistics & numerical data*; D012424:Rural Population; D013413:Sulfadoxine / Q000191:economics / Q000600:supply & distribution; D013636:Tanzania
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; C031327:artemisinin; D011739:Pyrimethamine