title: Determinants of malaria diagnostic uptake in the retail sector: qualitative analysis from focus groups in Uganda.
abstract: BACKGROUND
  In Uganda, as in most other malaria-endemic countries, presumptive treatment for malaria based on symptoms without a diagnostic blood test is still very common. While diagnostic testing in public sector facilities is increasing, many people in Uganda who suspect malaria visit private sector outlets to purchase medications. Increasing the availability and uptake of rapid diagnostic tests (RDTs) for malaria in private outlets could help increase diagnostic testing for malaria but raises questions about the patient demand for and valuation of testing that are less critical for public sector introduction.
  
  
  METHODS
  In preparation for a behaviour change campaign to encourage and sustain the demand for RDTs in drug shops, eight focus group discussions with a total of 84 community members were conducted in six districts across Uganda's Eastern Region in November-December 2011. Focus groups explored incentives and barriers to seeking diagnosis for malaria, how people react to test results and why, and what can be done to increase the willingness to pay for RDTs.
  
  
  RESULTS
  Overall, participants were very familiar with malaria diagnostic testing and understood its importance, yet when faced with limited financial resources, patients preferred to spend their money on medication and sought testing only when presumptive treatment proved ineffective. While side effects did seem to be a concern, participants did not mention other potential costs of taking unnecessary or ineffective medications, such as money wasted on excess drugs or delays in resolution of symptoms. Very few individuals were familiar with RDTs.
  
  
  CONCLUSIONS
  In order to boost demand, these results suggest that private sector RDTs will have to be made convenient and affordable and that targeted behaviour change campaigns should strive to increase the perceived value of diagnosis.
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA. cohenj@hsph.harvard.edu.
authors.forename: Jessica
authors.initials: J
authors.lastname: Cohen
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA. acox@mail.harvard.edu.
authors.forename: Alex
authors.initials: A
authors.lastname: Cox
authors.affiliation: Department of Economics, Northeastern University, Boston, MA, USA. w.dickens@neu.edu.
authors.forename: William
authors.initials: W
authors.lastname: Dickens
authors.affiliation: Malaria Control Team, Clinton Health Access Initiative, Boston, MA, USA. kmaloney@clintonhealthaccess.org.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Maloney
authors.affiliation: Essential Medicines Team, Clinton Health Access Initiative, Boston, MA, USA. flam@clintonhealthaccess.org.
authors.forename: Felix
authors.initials: F
authors.lastname: Lam
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA. gfink@hsph.harvard.edu.
authors.forename: Günther
authors.initials: G
authors.lastname: Fink
mesh_terms: D000328:Adult; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D008288:Malaria / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D017150:Public Sector; D011933:Reagent Kits, Diagnostic / Q000469:parasitology*; D014454:Uganda / Q000208:ethnology
chemical_list: D011933:Reagent Kits, Diagnostic