ACT Global Subsidy: Perspective from Diagnostics Wednesday July 18, 2007 APPMG Meeting ACT Global Subsidy: Perspective from Diagnostics Vinand M Nantulya FIND Foundation for Innovative New Diagnostics

ACT Global Subsidy Wide access to ACT is of interest and we fully endorse that. But diagnostics needs to be included in this debate. It is important to link malaria diagnosis to the subsidized ACT to avoid misuse and wastage of ACT. Misuse of current drugs is a major problem in both public and private sector and change may be more difficult in the informal sector.

Percentage over-prescription Country Proportion of patients treated for malaria on presumed diagnosis without laboratory confirmation Percentage over-prescription Ethiopia 1931/2490 78 The Gambia * 248/407 61 122/260 47 Germany 178/231 77 (travelers) Honduras 106/202 53 India * 1806/1945 2536/2885 93 (children) 88 (adults) 227/526 43 Indonesia 266/560 48 Malawi * 311/983 32 211/248 85 Nigeria 788/1384 57 Papua New Guinea 676/2096 Sahel countries 137/297 210/220 46 (wet season) 96 (dry season) Senegal 243/353 69 Tanzania * 237/380 62 134/272 49 46/164 28 Thailand * 953/1254 76 666/913 73 106/204 52 Uganda * 319/742 102/180 Zimbabwe * 189/261 72 207/287

Key issues at Country Level Bundling ACT with RDTs Ensuring quality of RDTs. Ensuring affordability of proper diagnosis and treatment.

Issue: Bundling ACT and RDTs Examine Uganda’s practical approach known as HOMAPAK. Originally designed to use Chloroquine/SP for home-based management of malaria fever in children using community health workers. ACT can be introduced into the kit together with RDTs.

Issue: Ensuring Quality of RDTs FIND is examining the possibility of tools to evaluate quality of RDTs, through the use of positive wells. These would empower governments to evaluate RDTs close to the point of actual use in the field. These tools could be available in 6 months.

Issue: Affordability of current RDTs For current RDTs, there is adequate competition in the market place. Local production could further bring down the price. For new RDTs that FIND is developing, the strategy is different as these will start as single or limited source.

Issue: Affordability of single source RDT

But the cost of diagnostics has two vital components Cost to Serve (up to 20% of cost of dx) Cost of Goods Provide solutions to bridge gaps and reduce costs + Training Quality assurance Maintenance Link price to volume (using GAMMSM or Global Accelerated Market Maturation) Hardware Laboratory strengthening (infrastructure) Partners Governments Bilateral organizations NGOs/Donors Software Quality Standardization Accountability ?Laboratory accreditation