1. 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

2. 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.

3. 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

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

5. 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.

6. 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.

7. 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.

8. Issue: Affordability of single source RDT

9. 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