title: Introducing rapid diagnostic tests for malaria into registered drug shops in Uganda: lessons learned and policy implications.
abstract: BACKGROUND
  Malaria is a major public health problem in Uganda and the current policy recommends introduction of rapid diagnostic tests for malaria (RDTs) to facilitate effective case management. However, provision of RDTs in drug shops potentially raises a new set of issues, such as adherence to RDTs results, management of severe illnesses, referral of patients, and relationship with caretakers. The main objective of the study was to examine the impact of introducing RDTs in registered drug shops in Uganda and document lessons and policy implications for future scale-up of malaria control in the private health sector.
  
  
  METHODS
  A cluster-randomized trial introducing RDTs into registered drug shops was implemented in central Uganda from October 2010 to July 2012. An evaluation was undertaken to assess the impact and the processes involved with the introduction of RDTs into drug shops, the lessons learned and policy implications.
  
  
  RESULTS
  Introducing RDTs into drug shops was feasible. To scale-up this intervention however, drug shop practices need to be regulated since the registration process was not clear, supervision was inadequate and record keeping was poor. Although initially it was anticipated that introducing a new practice of record keeping would be cumbersome, but at evaluation this was not found to be a constraint. This presents an important lesson for introducing health management information system into drug shops. Involving stakeholders, especially the district health team, in the design was important for ownership and sustainability. The involvement of village health teams in community sensitization to the new malaria treatment and diagnosis policy was a success and this strategy is recommended for future interventions.
  
  
  CONCLUSIONS
  Introducing RDTs into drug shops was feasible and it increased appropriate treatment of malaria with artemisinin-based combination therapy. It is anticipated that the lessons presented will help better implementation of similar interventions in the private sector.
authors.affiliation: Ministry of Health, Kampala and School of Public Health-College of Health Sciences, Makerere University, Box 7272, Kampala, Uganda. vpadmn@infocom.co.ug.
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Mbonye
authors.affiliation: Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Sian.Clarke@lshtm.ac.uk.
authors.forename: Sîan E
authors.initials: SE
authors.lastname: Clarke
authors.affiliation: Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Sham.lal@lshtm.ac.uk.
authors.forename: Sham
authors.initials: S
authors.lastname: Lal
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK. clare.chandler@lshtm.ac.uk.
authors.forename: Clare I
authors.initials: CI
authors.lastname: Chandler
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK. eleanor.hutchinson@lshtm.ac.uk.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Hutchinson
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK. Kristian.Hansen@lshtm.ac.uk.
authors.forename: Kristian S
authors.initials: KS
authors.lastname: Hansen
authors.affiliation: Department of Veterinary Disease and Biology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark. pma@sund.ku.dk.
authors.forename: Pascal
authors.initials: P
authors.lastname: Magnussen
mesh_terms: D003955:Diagnostic Tests, Routine / Q000379:methods*; D006291:Health Policy; D006302:Health Services Research; D006801:Humans; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy; D010594:Pharmacies; D011933:Reagent Kits, Diagnostic / Q000600:supply & distribution*; D014454:Uganda
chemical_list: D011933:Reagent Kits, Diagnostic