When clinics introduce rapid malaria tests, does unnecessary antimalarial prescribing decline, and do patients trust the tests?

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Malaria rapid diagnostic tests (RDTs) may assist diagnosis, improve prescribing practices and reduce the potential development of drug resistance. However, their costs may not be justified without understanding operational issues and how providers and patients accept and use them. The study aimed to evaluate RDTs’ impact on prescribing behaviour, assess prescribers’ and patients’ perceptions, and identify operational issues during implementation.

This was a baseline-to-implementation evaluation at six Tanzanian public dispensaries, combining prescribing data with interviews and qualitative methods. After baseline data collection, RDTs were implemented for eight weeks. Researchers collected data on how often RDTs were used, their results, malaria diagnoses and antimalarial prescriptions. Patients referred for RDTs completed a standardised exit interview. Qualitative methods assessed attitudes toward and satisfaction with RDTs, perceptions of the tests and operational issues during implementation.

Of 595 patients at baseline, 200 (33%) were clinically diagnosed with malaria but had a negative RDT. Among the 2519 RDTs performed during implementation, 289 (11.5%) had a negative result but were accompanied by an antimalarial prescription. The proportion of reported “over-prescriptions” was 54.8% (198/365) at baseline. It decreased to 16.1% (27/168) at week four and 16.4% (42/256) at week eight. Researchers conducted 355 individual interviews with patients or parents/caregivers, 21 individual interviews with prescribers, and 12 focus group discussions (FGDs).

Patients, caregivers and providers trusted RDT results, agreed that using RDTs was feasible at dispensary level, and perceived that the tests improved clinical diagnosis. Concerns included community suspicion and fear that the RDTs were HIV tests, the need for additional supervision when interpreting results, and increased workloads without additional compensation.

The study concluded that over-prescriptions decreased over the study period. Patient/caregiver and provider acceptance of and satisfaction with RDTs were high. The authors recommended that implementation include community education, sufficient training and supervision, and consideration of whether additional staff are needed.