1. Evaluation of home-based management of fever in urban Ugandan children Sarah Staedke London School of Hygiene & Tropical Medicine MU-UCSF Research Collaboration

2. Home-based management of fever (HBMF)  HBMF has been advocated to promote prompt appropriate treatment of malaria  In Uganda, HBMF has been launched Pre-packaged CQ+SP (Homapak) Community drug distributors Presumptive treatment of febrile children  Plans to introduce AL into HBMF in Uganda No data on the use of ACTs for HBMF are available Studies only with CQ, mostly seasonal transmission

3. Study objectives  To evaluate the utility of HBMF using AL in a cohort of children in Kampala  By comparing outcomes in children whose households were provided with AL to those from households without this intervention  Aim to evaluate the impact of HBMF vs. current standard of care for management of childhood fever on clinical outcomes and economic measures

4. Study procedures  Children aged 1-5 years recruited from Mulago III parish  Households completing pilot period were randomized to: HBMF: Households educated and given AL to keep at home for presumptive treatment of fever in participating children Standard care: Households instructed to continue their current approach to management of childhood illness  Clinical and laboratory evaluations At baseline, start, mid-point, and end of intervention  Household diaries, monthly questionnaires Information on illnesses, treatment-seeking behavior Visits to health care facilities, health care expenditures

5. HBMF COHORT Home-based care STANDARD CARE 212 children 159 households HBMF AL at home 225 children 166 households Target population = Mulago III parish U01 COHORT Health facility- based care 601 children (1-10y)

6. Primary outcome Treatment incidence density In U01, treatments for lab-confirmed cases of malaria In Standard care and HBMF, treatments for fever/malaria

7. Prompt appropriate therapy Incidence of treatments Standard careHBMFP-value Including an appropriate antimalarial* 0.984.31< 0.0001 Given within 24 hours (prompt) 1.893.55< 0.0001 Prompt appropriate antimalarial 0.172.43< 0.0001 Antibiotic treatment2.402.090.180 HBMF → increase in prompt and appropriate antimalarial therapy * Appropriate antimalarial → CQ+SP, quinine, Coartem, artemisinins

8. Summary  Results on HBMF in Kampala are mixed (+) Marked improvement in drug delivery (+) Modest clinical benefit (–) Substantial over-treatment  Delay in treatment seeking for non-malarial illnesses  Over-treatment may drive drug resistance (–) Less cost-effective  Future directions Similar study comparing health facility-based treatment to HBMF with AL vs. DP in Tororo Funded by Gates / ACT Consortium

9. Thanks Christopher Whitty Gates Malaria Partnership Phil, Grant, Moses Norah and HBMF team