Denise Njama-Meya
University
Faculty of Medicine and School of Public Health, Makerere University, Kampala, Uganda.
PhD Title
Evaluating the cost-effectiveness and the epidemiological effect of introducing rapid diagnostic tests (RDTs) within the Ugandan health system at varying levels of malaria endemicity.
Abstract
Uganda recently proposed to introduce malaria rapid diagnostic tests (RDTs) as an effort to increase use of parasitologic diagnosis for malaria following its policy change to use artemether/lumefantrine as first line treatment for uncomplicated malaria. Although, introduction of RDTs can potentially ensure more accurate use of ACTs its’ cost effectiveness will largely depend on if health workers prescribe logically on the basis of test results. The main objective will be to evaluate the cost-effectiveness and the epidemiological effect of introducing RDTs within the Ugandan health system at varying levels of malaria endemicity. The study will be in 3 districts in Uganda with varying malaria endemicity, determined by assessing slide positivity rates at selected facilities nationwide. Cost effectiveness of introducing RDTs compared to clinical diagnosis and field microscopy will be assessed at all health facility levels. Costs to the service providers, of introducing and maintaining RDTs for a period of one year will be determined. Evaluation of the effectiveness will be by assessing the health providers’ compliance with directives for use of RDTs in management of febrile illnesses. Probability sensitivity analysis will be applied with RDTs defined as cost-effective if they were less costly. Using the HMIS data we will assess the incidence of malaria morbidity, mortality, severe malaria and hospitalizations pre and post introduction of RDTs. We will also follow up a cohort of febrile patients with negative RDTs who do not receive an antimalarial to determine their outcome.