Affordable Medicines Facility improves access to anti-malarials

The Affordable Medicines Facility-malaria (AMFm) has resulted in significant improvements in the availability and price of quality-assured artemisinin-based combination therapies (QAACTs) in seven African countries after 1 year, show study findings published in The Lancet.

"Africa is home to 80% of malaria cases, yet most of the population do not have access to affordable ACTs," said study author Kara Hanson (The London School of Hygiene and Tropical Medicine, UK) in a press statement.

"Access is restricted by unreliable public health facility supply, high prices, and limited availability in the private sector where most people go to buy medicines," she commented, adding that cheaper, less effective anti-malarial drugs are readily available, including artemisinin monotherapies that "can encourage development of resistance to ACTs."

To try and improve access to QAACTs in countries with a high malarial burden, the AMFm was set up in 2012 by the Global Fund.

Lead investigator Sarah Tougher, also from The London School of Hygiene and Tropical Medicine, and colleagues carried out surveys in Ghana, Kenya, Madagascar, Niger, Nigeria, Uganda, and Tanzania to assess the impact of the AMFm 1 year on.

They found that QAACT availability went up significantly by 25.8-51.9 percentage points and the market share of QAACTs increased by 15.9-40.3 percentage points in all the pilot countries except Niger and Madagascar.

Large decreases in the price of QAACTs per adult equivalent dose were also observed in the private for-profit sector in all countries except Uganda, ranging from US$ 1.28-4.82 (€ 0.98-3.72).

"It is clear that tapping into the private sector distribution chain can have a major influence on which anti-malarial treatments are available and their price and quality in just a few months, but more information is needed about whether the subsidized drugs are reaching those most in need and on how diagnostics can be scaled up in the public and private sectors," said Hanson.

Ramanan Laxminarayan (Center for Disease Dynamics, Economics and Policy, Washington, DC, USA) and co-authors of an accompanying commentary support the continuation of the AMFm.

"We must acknowledge that an efficient approach to subsidising antimalarial drugs has worked, making them available in the private sector where people go to buy them," they conclude.

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