title: Effect of the Affordable Medicines Facility--malaria (AMFm) on the availability, price, and market share of quality-assured artemisinin-based combination therapies in seven countries: a before-and-after analysis of outlet survey data.
abstract: BACKGROUND
  Malaria is one of the greatest causes of mortality worldwide. Use of the most effective treatments for malaria remains inadequate for those in need, and there is concern over the emergence of resistance to these treatments. In 2010, the Global Fund launched the Affordable Medicines Facility--malaria (AMFm), a series of national-scale pilot programmes designed to increase the access and use of quality-assured artemisinin based combination therapies (QAACTs) and reduce that of artemisinin monotherapies for treatment of malaria. AMFm involves manufacturer price negotiations, subsidies on the manufacturer price of each treatment purchased, and supporting interventions such as communications campaigns. We present findings on the effect of AMFm on QAACT price, availability, and market share, 6-15 months after the delivery of subsidised ACTs in Ghana, Kenya, Madagascar, Niger, Nigeria, Uganda, and Tanzania (including Zanzibar).
  
  
  METHODS
  We did nationally representative baseline and endpoint surveys of public and private sector outlets that stock antimalarial treatments. QAACTs were identified on the basis of the Global Fund's quality assurance policy. Changes in availability, price, and market share were assessed against specified success benchmarks for 1 year of AMFm implementation. Key informant interviews and document reviews recorded contextual factors and the implementation process.
  
  
  RESULTS
  In all pilots except Niger and Madagascar, there were large increases in QAACT availability (25·8-51·9 percentage points), and market share (15·9-40·3 percentage points), driven mainly by changes in the private for-profit sector. Large falls in median price for QAACTs per adult equivalent dose were seen in the private for-profit sector in six pilots, ranging from US$1·28 to $4·82. The market share of oral artemisinin monotherapies decreased in Nigeria and Zanzibar, the two pilots where it was more than 5% at baseline.
  
  
  CONCLUSIONS
  Subsidies combined with supporting interventions can be effective in rapidly improving availability, price, and market share of QAACTs, particularly in the private for-profit sector. Decisions about the future of AMFm should also consider the effect on use in vulnerable populations, access to malaria diagnostics, and cost-effectiveness.
  
  
  BACKGROUND
  The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Bill & Melinda Gates Foundation.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK. sarah.tougher@lshtm.ac.uk
authors.forename: Sarah
authors.initials: S
authors.lastname: Tougher
authors.forename: Yazoume
authors.initials: Y
authors.lastname: Ye
authors.forename: John H
authors.initials: JH
authors.lastname: Amuasi
authors.forename: Idrissa A
authors.initials: IA
authors.lastname: Kourgueni
authors.forename: Rebecca
authors.initials: R
authors.lastname: Thomson
authors.forename: Catherine
authors.initials: C
authors.lastname: Goodman
authors.forename: Andrea G
authors.initials: AG
authors.lastname: Mann
authors.forename: Ruilin
authors.initials: R
authors.lastname: Ren
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Willey
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Adegoke
authors.forename: Abdinasir
authors.initials: A
authors.lastname: Amin
authors.forename: Daniel
authors.initials: D
authors.lastname: Ansong
authors.forename: Katia
authors.initials: K
authors.lastname: Bruxvoort
authors.forename: Diadier A
authors.initials: DA
authors.lastname: Diallo
authors.forename: Graciela
authors.initials: G
authors.lastname: Diap
authors.forename: Charles
authors.initials: C
authors.lastname: Festo
authors.forename: Boniface
authors.initials: B
authors.lastname: Johanes
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Juma
authors.forename: Admirabilis
authors.initials: A
authors.lastname: Kalolella
authors.forename: Oumarou
authors.initials: O
authors.lastname: Malam
authors.forename: Blessing
authors.initials: B
authors.lastname: Mberu
authors.forename: Salif
authors.initials: S
authors.lastname: Ndiaye
authors.forename: Samuel B
authors.initials: SB
authors.lastname: Nguah
authors.forename: Moctar
authors.initials: M
authors.lastname: Seydou
authors.forename: Mark
authors.initials: M
authors.lastname: Taylor
authors.forename: Sergio Torres
authors.initials: ST
authors.lastname: Rueda
authors.forename: Marilyn
authors.initials: M
authors.lastname: Wamukoya
authors.forename: Fred
authors.initials: F
authors.lastname: Arnold
authors.forename: Kara
authors.initials: K
authors.lastname: Hanson
mesh_terms: D000349:Africa; D000962:Antimalarials / Q000191:economics* / Q000592:standards / Q000600:supply & distribution; D037621:Artemisinins / Q000191:economics* / Q000592:standards / Q000600:supply & distribution; D016527:Drug Costs; D006801:Humans; D007783:Lactones / Q000191:economics* / Q000592:standards / Q000600:supply & distribution; D008288:Malaria / Q000188:drug therapy* / Q000191:economics; D008389:Marketing of Health Services; D010594:Pharmacies / Q000191:economics / Q000706:statistics & numerical data; D010865:Pilot Projects; D017149:Private Sector / Q000191:economics; D017150:Public Sector / Q000191:economics
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D007783:Lactones; C075875:artemisin