CAPSS (Consortium for ACT private sector subsidy)
Private-sector drug sellers are often the first point of call for about 60% of people who seek treatment for fever in Uganda. Artemisinin-based combination treatments (ACTs) are usually prohibitively priced at such outlets, if they are stocked at all. This leads patients to purchase ineffective drugs such as chloroquine, sub-standard treatments or partial dosages of effective treatments, as these are often all they can afford.
From 2008 to 2010, in collaboration with its partners, MMV assessed whether subsidizing ACTs in the private sector would bring effective treatment within reach of those that need it.
Access in Action
- The CAPSS pilot in Uganda was co-designed by MMV, explored the approach of providing subsidized drugs in combination with supporting interventions, such as dispenser training, community sensitization and mobilization, appropriate pricing, distribution and adequate retail margins.
- The partner consortium was co-managed by MMV and the results of the pilot published as a comment in The Lancet. The results showed that a subsidy achieved a significant increase in the use of ACTs, reduced the purchase price of these quality drugs, and ensured that the correct dosages were sold by a large proportion of retail outlets.
Uganda Ministry of Health, National Drug Authorities, PSI/PACE, Malaria Consortium, Surgipharm
Inappropriate use of antimalarials can lead to poor patient outcomes and contribute to the development of artemisinin resistance. WHO’s T3 initiative– Test, Treat, Track - advocates for intensified efforts to ensure confirmatory diagnosis before patients are treated with antimalarial medicines.
Building on the success of the CAPSS project, between 2012-2013, MMV and partners piloted CAPSS Plus to determine whether efforts to expand access to affordable malaria medicines can also bolster better overall management of patients with fever by including rapid diagnostic tests (RDTs) in private sector settings.
Access in Action
- The CAPSS Plus pilot in Uganda was co-designed by MMV and builds on the CAPSS framework by incorporating the use of rapid diagnostic tests (RDTs) and by training drug shop keepers on the treatment of non-malarial fevers.
- The pilot evaluated the feasibility and acceptability of licensed Ugandan drug shops providing a malaria diagnostic test before selling subsidized ACTs to patients or providing treatment for other common causes of infection.
- The baseline analysis for this study was published in The American Journal of Tropical Medicine and Hygiene. The final conclusions of this pilot were published in PLoS One, and concluded that an integrated community case management (ICCM) approach to childhood illnesses can be adapted for drug shops to diminish the presumptive treatment of malaria and to increase the integrated assessment and care of children with fever.
Karolinska Institute, Makarere University, PSI/PACE, Premier Medical Corporation