Rapid diagnostic tests for targeting antimicrobial treatment

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In many countries, the majority of antimicrobials are acquired outside of the formal health sector, from small shops and informal providers. The appeal to include these shops in stewardship campagins is strong. However, a qualitative study published this week by anthropologist Eleanor Hutchinson and colleagues at LSHTM adds a note of caution on the complexities of implementing in this arena. Strengthening one aspect of performance in these shops can raise their status and clientbase, but treatment seekers may overall receive poorer quality and more costly care. The qualitative study was carried out alongside a cluster randomised trial to evaluate the impact of malaria rapid diagnostic tests (RDTs) on the overuse of antimalarials in private drug shops in Uganda and was published the BMJ Global Health. The main trial findings showed a dramatic reduction in antimalarial prescribing: 62% patients presenting to shops in the RDT arm got an antimalarial compared with nearly 100% patients presenting to the control arm shops without the RDT intervention. The qualitative study showed that while antimalarial prescribing decreased, sales of other medicines increased, and furthermore that the appeal of such services in the convenience of drug shops appeared to shift treatment seeking from the public sector into these shop settings. The authors raise the issue of additional activities and infrastructure required for stewardship programmes to be effective and to strengthen health systems. They propose that a significant increase in surveillance and supervision is likely to be necessary in order to guard against poor quality and inequitable practices that may increase out of pocket payments among those who can least afford them. This is especially the case in settings in settings in which there is little regulation and oversight of practice.

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