title: Introducing malaria rapid diagnostic tests in private medicine retail outlets: A systematic literature review.
abstract: BACKGROUND
  Many patients with malaria-like symptoms seek treatment in private medicine retail outlets (PMR) that distribute malaria medicines but do not traditionally provide diagnostic services, potentially leading to overtreatment with antimalarial drugs. To achieve universal access to prompt parasite-based diagnosis, many malaria-endemic countries are considering scaling up malaria rapid diagnostic tests (RDTs) in these outlets, an intervention that may require legislative changes and major investments in supporting programs and infrastructures. This review identifies studies that introduced malaria RDTs in PMRs and examines study outcomes and success factors to inform scale up decisions.
  
  
  METHODS
  Published and unpublished studies that introduced malaria RDTs in PMRs were systematically identified and reviewed. Literature published before November 2016 was searched in six electronic databases, and unpublished studies were identified through personal contacts and stakeholder meetings. Outcomes were extracted from publications or provided by principal investigators.
  
  
  RESULTS
  Six published and six unpublished studies were found. Most studies took place in sub-Saharan Africa and were small-scale pilots of RDT introduction in drug shops or pharmacies. None of the studies assessed large-scale implementation in PMRs. RDT uptake varied widely from 8%-100%. Provision of artemisinin-based combination therapy (ACT) for patients testing positive ranged from 30%-99%, and was more than 85% in five studies. Of those testing negative, provision of antimalarials varied from 2%-83% and was less than 20% in eight studies. Longer provider training, lower RDT retail prices and frequent supervision appeared to have a positive effect on RDT uptake and provider adherence to test results. Performance of RDTs by PMR vendors was generally good, but disposal of medical waste and referral of patients to public facilities were common challenges.
  
  
  CONCLUSIONS
  Expanding services of PMRs to include malaria diagnostic services may hold great promise to improve malaria case management and curb overtreatment with antimalarials. However, doing so will require careful planning, investment and additional research to develop and sustain effective training, supervision, waste-management, referral and surveillance programs beyond the public sector.
authors.affiliation: Clinton Health Access Initiative, Boston, Massachusetts, United States of America.
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authors.lastname: Visser
authors.affiliation: Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom.
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authors.affiliation: Bill and Melinda Gates Foundation, Seattle, Washington, United States of America.
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authors.affiliation: Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Toby
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authors.affiliation: US President's Malaria Initiative, United States Agency for International Development, Washington DC, United States of America.
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authors.affiliation: Mentor Initiative, West Sussex, United Kingdom.
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authors.affiliation: Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom.
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authors.affiliation: Harvard T.H. Chan School of Public Health, Boston, United States of America.
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authors.affiliation: Clinton Health Access Initiative, Boston, Massachusetts, United States of America.
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authors.affiliation: Population Services International, Nairobi, Kenya.
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authors.affiliation: Clinton Health Access Initiative, Boston, Massachusetts, United States of America.
authors.forename: Caitlin
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authors.lastname: Dolkart
authors.affiliation: Mentor Initiative, West Sussex, United Kingdom.
authors.forename: Katie
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authors.affiliation: Harvard T.H. Chan School of Public Health, Boston, United States of America.
authors.forename: Günther
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authors.affiliation: Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom.
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authors.affiliation: Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom.
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authors.affiliation: Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Sham
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authors.affiliation: Ministry of Health, Kampala, Uganda.
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authors.affiliation: University of Enugu, Agbani, Enugu State, Nigeria.
authors.forename: Obinna
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authors.affiliation: Clinton Health Access Initiative, Boston, Massachusetts, United States of America.
authors.forename: Nora
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authors.lastname: Petty
authors.affiliation: Mentor Initiative, West Sussex, United Kingdom.
authors.forename: Julie
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authors.lastname: Pontarollo
authors.affiliation: Population Services International, Nairobi, Kenya.
authors.forename: Stephen
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authors.lastname: Poyer
authors.affiliation: Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: David
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authors.lastname: Schellenberg
authors.affiliation: Malaria Consortium, London, United Kingdom.
authors.forename: Elizabeth
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authors.lastname: Streat
authors.affiliation: Clinton Health Access Initiative, Boston, Massachusetts, United States of America.
authors.forename: Abigail
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authors.affiliation: Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom.|School of Public Health and Community Medicine, University of New South Wales, UNSW, Sydney, Australia.
authors.forename: Virginia
authors.initials: V
authors.lastname: Wiseman
authors.affiliation: Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Christopher J M
authors.initials: CJ
authors.lastname: Whitty
authors.affiliation: Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom.|Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Shunmay
authors.initials: S
authors.lastname: Yeung
authors.affiliation: Global Malaria Program, World Health Organization, Geneva, Switzerland.
authors.forename: Jane
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authors.lastname: Cunningham
authors.affiliation: Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom.
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mesh_terms: D006801:Humans; D008288:Malaria / Q000175:diagnosis*; D017149:Private Sector; D011933:Reagent Kits, Diagnostic
chemical_list: D011933:Reagent Kits, Diagnostic