title: Can Rapid Diagnostic Testing for Malaria Increase Adherence to Artemether-Lumefantrine?: A Randomized Controlled Trial in Uganda.
abstract: Most patients with suspected malaria do not receive diagnostic confirmation before beginning antimalarial treatment. We investigated the extent to which uncertainty about malaria diagnosis contributes to patient nonadherence to artemether-lumefantrine (AL) treatment through a randomized controlled trial in central Uganda. Among 1,525 patients purchasing a course of AL at private drug shops, we randomly offered 37.6% a free malaria rapid diagnostic test (RDT) and then assessed adherence through home visits 3 days later. Of these subjects, 68.4% tested positive for malaria and 65.8% adhered overall. Patients who tested positive did not have significantly higher odds of adherence than those who were not offered the test (adjusted odds ratio [OR]: 1.07, 95% confidence interval [CI]: 0.734-1.57,P= 0.719). Patients who received a positive malaria test had 0.488 fewer pills remaining than those not offered the test (95% CI: -1.02 to 0.043,P= 0.072). We found that patients who felt relatively healthy by the second day of treatment had lower odds of completing treatment (adjusted OR: 0.532, 95% CI: 0.394-0.719,P< 0.001). Our results suggest that diagnostic testing may not improve artemisinin-based combination therapy adherence unless efforts are made to persuade patients to continue taking the full course of drugs even if symptoms have resolved.
authors.affiliation: Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Innovations for Poverty Action, Kampala, Uganda.
authors.forename: Indrani
authors.initials: I
authors.lastname: Saran
authors.affiliation: Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Innovations for Poverty Action, Kampala, Uganda.
authors.forename: Elif
authors.initials: E
authors.lastname: Yavuz
authors.affiliation: Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Innovations for Poverty Action, Kampala, Uganda.
authors.forename: Howard
authors.initials: H
authors.lastname: Kasozi
authors.affiliation: Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Innovations for Poverty Action, Kampala, Uganda cohenj@hsph.harvard.edu.
authors.forename: Jessica
authors.initials: J
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use*; D000077549:Artemether; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000008:administration & dosage / Q000627:therapeutic use*; D004338:Drug Combinations; D004983:Ethanolamines / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005449:Fluorenes / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D000078102:Lumefantrine; D008288:Malaria / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D000067716:Point-of-Care Testing; D014454:Uganda; D016903:Drug Monitoring
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; D000077549:Artemether; D000078102:Lumefantrine