Person:

Lanthorn, Heather Elisabeth

Background: Low rates of adherence to artemisinin-based combination therapy (ACT) regimens increase the risk of treatment failure and may lead to drug resistance, threatening the sustainability of current anti-malarial efforts. We assessed the impact of text message reminders on adherence to ACT regimens. Methods: Health workers at hospitals, clinics, pharmacies, and other stationary ACT distributors in Tamale, Ghana provided flyers advertising free mobile health information to individuals receiving malaria treatment. The messaging system automatically randomized self-enrolled individuals to the control group or the treatment group with equal probability; those in the treatment group were further randomly assigned to receive a simple text message reminder or the simple reminder plus an additional statement about adherence in 12-hour intervals. The main outcome was self-reported adherence based on follow-up interviews occurring three days after treatment initiation. We estimated the impact of the messages on treatment completion using logistic regression. Results: 1140 individuals enrolled in both the study and the text reminder system. Among individuals in the control group, 61.5% took the full course of treatment. The simple text message reminders increased the odds of adherence (adjusted OR 1.45, 95% CI [1.03 to 2.04], p-value 0.028). Receiving an additional message did not result in a significant change in adherence (adjusted OR 0.77, 95% CI [0.50 to 1.20], p-value 0.252). Conclusion: The results of this study suggest that a simple text message reminder can increase adherence to antimalarial treatment and that additional information included in messages does not have a significant impact on completion of ACT treatment. Further research is needed to develop the most effective text message content and frequency. Trial Registration ClinicalTrials.gov NCT01722734

My research examines the adoption and implementation processes involved in transferring a global health policy into national-level practice. More specifically, I consider how high-level stakeholders adopted and street-level, private-sector retailers implemented the Phase I pilot of the Affordable Medicines Facility- malaria (AMFm) between mid-2009 and end-2011. The AMFm — a large-scale program housed at the Global Fund to Fight AIDS, TB and Malaria — sought to improve access to high-quality malaria treatment through financing and delivery strategies using the public and private sectors. To date, the median implementation outcomes have been considered in the Independent Evaluation commissioned by the Global Fund but country-level processes and nuanced considerations of outcomes have gone unexplored. To better understand the AMFm pilot in Ghana, I collected both quantitative and qualitative data between August and December 2011.

To consider adoption, I first use a grounded, qualitative approach to address: What explains the stands taken by national stakeholders towards and against participating in the AMFm’s Phase I? I generate explanatory categories about the different views — stands — key stakeholders in Ghana took about joining Phase I. Public health goals; indirect policy goals; and concerns about personal, organization, and national reputation help to explain the views of different high-level stakeholders. Second, I consider the actions taken by different stakeholders: To what extent can a multiple-streams approach to policy adoption help clarify Ghana’s decision to join in the AMFm’s pilot? I find the Multiple-Streams Approach cannot be used to explain adoption of the AMFm pilot in Ghana. However, a modified version accounting for the global and national levels simultaneously can explain this case.

To consider implementation, I ask: Do retailers in Northern Region comply with Ghana’s the advertised AMFm Recommended Retail Price among for-profit, private-sector retailers? And, does non-compliance vary systematically with features of retailer structure or conduct? I find high compliance based on reported retail prices. I also find that neither measures of spatial competition nor having seen regulation enforced in the past explain the pattern of non-compliance. Rather, variation in the terminal supply price is highly associated with a retailer’s decision to charge at or above the RRP.