Table 3 Outcomes of testing and treatment
From: Point-of-care testing in private pharmacy and drug retail settings: a narrative review
Ref no | First author | Year published | Sample size | Intended treatment for the Targeted Disease | Description of intervention arm(s) | POCT uptake | POCT positivity (% of patients receiving an POCT who tested positive) | Treatment provision: proportions of all study participants receiving treatment(s) intended for those testing positive |
|---|---|---|---|---|---|---|---|---|
[23] | Ansah | 2015 | 4603 clients attending 24 clusters of shops (each containing 1 to 5 shops) | Artemisinin combination therapy: amodiaquine-artesunate, arthemeter-lumefantrine, or dihydroartemisinine-piperaquine | Shops were trained to carry out a malaria POCT before dispensing medication | 100% | 49.70% | Based on POCT results: 78.8% (2142/2719, based on POCTs) 65.3% (3005/4603, based on research slides) |
[35] | Audu | 2016 | 1200 at 6 private retail pharmacies | Artemether-lumefantrine | Shops were trained on the use of malaria POCT before dispensing medication | NA | 43% | Control arm: 98.2% Intervention arm: 78.3% (100% of those of tested positive and 62% of those who tested negative) |
[36] | Aung | 2015 | 832 fever cases at 631 POCT outlets | Antimalarials | Arm 1: price subsidy for POCT resupply and monthly check-in visit. Arm 2: price subsidy for POCT and financial/product-related incentives. Arm 3: price subsidy for POCT and monthly intensive support visits by health officers | Arm 1: from 3.0% to 6.4% Arm 2: from 2.7% to 11.9%, Arm 3: from 5.4% to 13.0% | NA | NA |
[24] | Awor | 2014 | Intervention: 487 children with fever at across 44 shops Control: 275 children with fever across 40 shops | Antimalarials for malaria or amoxicillin, oral rehydration solution and zinc sulfte tablets for pneumonia | Shops were trained and provided with subsidised diagnostics and drugs and a community awareness campaign, following “integrated community case management”-style intervention | From 0% to 87.7% of children with fever (427/487) | 75% (44/47, based on direct observation) | 70.4% (343/487, based on exit interviews) 70.2% (33/47, based on direct observation) |
[37] | Awor | 2015 | 6140 children with fever across 44 shops | Antimalarials, oral rehydration solution and zinc sulfte tablets for pneumonia | Shops were trained and provided with subsidised diagnostics and drugs and a community awareness campaign, following “integrated community case management”-style intervention | 97.5% of children with fever (5986/6140) | 85.1% (5096/5986) | 85% (5218/6140) |
[38] | Cohen | 2012 | 58 villages offering POCTs (87% of total number of villages) | Artemisinin-based combination therapy or other antimalarials | Shops were trained on tests and told to proceed as they would normally based on whether they thought the client had malaria or not after the test | 16% of those with fever | 89% | ACT 32% of those testing positive 9% of those testing negative 26.4% of those not tested at all Other antimalarials 66.4% of those testing positive 33.3% of those testing negative 35% of those not tested at all |
[26] | Hansen | 2017 | 7522 in intervention, 5797 in control arm | Artemisinin combination therapy | Drug shops trained on how to perform and interpret malaria POCT and prescribe subsidised ACT based on POCT results | 100% | 43.50% | Intervention: 61% Control: 100% |
[39] | Hutchinson | 2015 | 21 focus group discussions (no info on how many people per focus group) 12 months after implementation | Artemisinin combination therapy | Drug shops were trained on POCT usage and decided to treat based on results of POCT | |||
[40] | Hutchinson | 2017 | Staff from 59 drug shops, divided into 21 focus groups (each having btw 5 to 13 participants) | Artemisinin combination therapy | Pharmacies were trained to recognise malaria based on POCTs and decide to treat based on the POCT outcome | 97.60% | 57.50% | 52.70% |
[41] | Ikwuobe | 2013 | 619 patients in intervention, 607 in contorl, btw 2 pharmacies; total of 1226 participants | Antimalarials | Pharmacists were trained on and provided with POCTs and tested those with anti-malarial prescription or wanting to self-medicate with them, then allowed to proceed with dispensing of drugs following discussion between pharmacist and patient | NA | 13.6% (84/619) | 58.2% (360/619) |
[42] | Kitutu | 2017 | 3738 child fever cases across 61 drug shops in intervention arm | Artemisinin for malaria, amoxicilllin for pneumonia, zinc sulfate solution for non-bloody diarrhoea | Drug shops were trained in integrated community case management to provide POCT testing for children with malaria, consisting of training of drug sellers, provision of information, education and communication, supplying diagnostics and medicines, and monthly supportive supervision | 97% (3628/3738) | 47% (1957/4190) | NA |
[43] | Kwarteng | 2019 | 1973 clients across 42 licensed chemical shops | Antimalarials | Pharmacies and licensed chemical shops were trained on use of malaria POCTs and treated based on national malaria treatment guidelines | NA | 60.2% (1081/1797) | 60.2% (1082/1797) |
[44] | Maloney | 2017 | 1214 patients across 262 drug dispensing outlets | Antimalarials | Arm 1: training, access to and supervision on use of POCTs to treat clients Arm 2: same as Arm 1 but also received subsidised POCTs and sold at subsidized price | Intervention: increased from 19 to 74%, cntrol: increased from 3 to 18% | 41% | NA |
[34] | Mbonye | 2015 | 15517 patients (8672 intervention and 6845 control) across 59 drug shops | Artemisinin combination therapy | Drug shops were additionally trained on use of malaria POCT, and asked to manage patients based on POCT results using subsidized ACT | 97.8 | 58.50% | Intervention: 62.5% Control: 99.8% |
[33] | Mboyne | 2015 | Policy implications of Mboyne et al. (2015) | |||||
[45] | Onwunduba | 2023 | ||||||
[46] | O' Meara | 2016 | 444 participants across 11 shops | Artemisinin combination therapy | Arm 1: Free POCT and conditional ACT subsidy Arm 2: Free POCT but no ACT subsidy Arm 3: No POCT subsidy but conditional ACT subsidy Arm 4: No POCT or ACT subsidy | Arm 1: 73.7% Arm 2: 73.8% Arm 3: 49.6% Arm 4: 51.0% | Arm 1: 39.3% Arm 2: 27.6% Arm 3: 44.6% Arm 4: 47.1% | Arm 1: 43.9% Arm 2: 25.9% Arm 3: 32.8% Arm 4: 29% |
[47] | Poyer | 2018 | 633 clients in second round at 120 outlets, but high rates of dropout | Antimalarials | Private health facilities (PHF) and pharmacies (P) were trained in use of malaria POCTs and offered them to febrile patients | PHF: from 30.4% to 52.6% P: from 52.1% to 56.3% | PHF: from 52.3% to 45.1% P: from 47.2% to 52.8% | PHF; from 42.5% to 41.8% P: from 31% to 29.4% |
[48] | Shelus | 2023 | 934 clients of drug shops | Antimalarial | Drug shops offered malarial POCTs to febrile clients or clients seeking antimalarials for themselves or for others and recorded the medication purchased by these clients | 36% | 43% | 79.40% |
[49] | Simmalavong | 2017 | 2,301,676 tests across 317 pharmacies | Artemether/lumefantrine | Private pharmacies were trained on and supplied with POCTs and antimalarials to diagnose and treat malaria as part of a public–private scheme to increase diagnostics in private clinics, which was then scaled up over time | NA | ||
[50] | Soniran | 2022 | 637 caregivers of febrile children under 10 yo and 48 mystery cleint visits | ACT | Over-the-counter medicine selllers were trained to sight patients suspected of malaria and conduct a test on thembefore prescribing antimalarials to patients testing positive | 30.8% (intervention; household survey) or 38.1% (intervention; mystery client); 10.5% (control; household survey) or 23.3% (control; mystery client) | 25.0% (intervention, mystery client) vs 42.9% (control, mystery client) | 33.3% (intervention, mystery client) vs 53.3% (control, mystery client) |
[51] | Sudhinaraset | 2015 | 30 informal providers of POCTs | Antimalarials | Arm 1: subsidised POCTs Arm 2: subsidised POCTs and free POCT for every 5 purchased by providers Arm 3: subsidised POCTs and information, education and counselling | NA | ||
[52] | Thet | 2021 | 80 malaria drug shops for quantitative and 65 of these for qualitative interviews | "Effective and quality" antimalarial drugs | Drug shops participated in nationwide project to replace widespread use of artemisinin monotherapy with combination therapy, and were trained to perform malaria POCT to guide management of clients | NA | NA | NA |
Ref no | Treatment provision: % of patients not tested receiving the intended treatment for the study's targeted diseases | Adherence: % of patients with a negative POCT result not receiving the intended treatment for the study's targeted diseases | Adherence: % of patients with a positive POCT result receiving the intended treatment for the study's targeted diseases | % of patients tested positive referred elsewhere by the provider for further care | Safety & Accuracy of administration of testing (% of providers who could accurately perform an POCT, read its result and dispose of waste) | Accuracy of POCT (sensitivity, specificity, positive predictive value or other quality measures) | Retail price (USD) |
|---|---|---|---|---|---|---|---|
[23] | Control: 93% (slide-positive), 88% (slide-negative) | 97% | 99.50% | 0.52% (7/1351) | 87.2% to 100% of different safety indicators | Sensitivity: 98–100% by shop Specificity: 73% to 98%, some 30%, 31%, 52% | 0 |
[35] | 98.20% | 38% | 100% | NA | NA | Sensitivity: 97.3% Specificity: 98.5% Positive predictive value: 98.0% | NA |
[36] | NA | NA | NA | NA | 94% | NA | 0.18 |
[24] | NA | 90.9% (10/11, based on direct observation) | 100% (33/33, based on direct observation) | NA | 94% | NA | 0 |
[37] | NA | NA | 93.5% (4961/5307) | NA | NA | NA | NA |
[38] | 61.40% | 57.70% | 98.40% | NA | > 95% for POCT administration and procedure adherence | Lot-testing: 100% passed | 0.40 (ranged between 0–2) |
[26] | 100% | 98.60% | 99.10% | NA | NA | Sensitivity: 91.75% Specificity: 62.92% | 0.2 |
[39] | |||||||
[40] | 99.20% | 70.30% | 94.30% | NA | NA | 2 (between 0.08–13.20 USD in mPOCT negative); 1.62 (between 0.12–12.80 USD in mPOCT positive); 1.32 (between 0.32–18.00 USD in control arm) | |
[41] | Control: 100% (607/607) | 48.4% (259/535) | 100% (84/84) | NA | NA | Sensitivity: 100% Specificity: 100% | 0 |
[42] | NA | NA | 73.9% (based on exit interviews) 88.7% (based on pharmacist record) 63.3% (based on direct observation) | NA | NA | NA | 0 |
[43] | NA | 73.9% (529/716) | 82.79% (895/1081) | NA | 94.9% (1873/1973) | NA | NA |
[44] | Intervention: 35% Control: 41%l | 93% | 90% | NA | NA | NA | 0.32 (subsidised) and 0.67 (not subsidised) |
[34] | Intervention: 51.4%-73.7% Control: 99.6%-100.0% | 98.5% (3117/3166) | 99% (4858/4907) | NA | 95% of POCTs read correctly | Sensitivity: 91.7% Specificity: 63.1% | 0.2 |
[33] | |||||||
[45] | |||||||
[46] | Arm 1: 30%, Arm 2: 29.6%, Arm 3: 21.1%, Arm 4: 26.5% | Arm 1: 72.5%, Arm 2: 80.0%, Arm 3: 87.1%, Arm 4: 92.6% | Arm 1: 81.8%, Arm 2: 71.4%, Arm 3: 84%, Arm 4: 58.3% | NA | NA | NA | 0 or 0.50 |
[47] | PHF: from 8.4% to 19.8% P: from 40.8% to 22.2% | PHF: from 93.3% to 96.1% P: from 86.1% to 100% | PHF: from 84.6% to 91.6% P: from 86.8% to 92.6% | 0% | PHF: from 25.3–97.8% to 14.7–100% P: from 33.3–100% to 20.7–97.7% | 0.8 or 1 for hospital or single pack POCT respectively (suggested prices) | |
[48] | 87.30% | 63.70% | 93.60% | NA | NA | NA | 0.57 |
[49] | |||||||
[50] | From 47.1% to 66.7% (before and after intervention, household survey) 34.6% (Intervention, mystery client) vs 52.2% (Control, mystery client) | 83.3% (Intervention, mystery client) vs 75.0% (Control, mystery client) | 75.0% (Intervention, mystery client) vs 100% (Control, mystery client) | NA | 66.7% (intervention, mystery client) vs 40% (control, mystery client) | NA | 0.44 |
[51] | |||||||
[52] | NA | 73.90% of drug shops | NA | NA | NA | NA | NA |