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Artemisinine Combination Therapy Consortium 

Institutions in charge of project: London School of Hygiene and Tropical Medicine

Goals and Objectives

General objective.

To optimize the public health impact of large-scale deployment of artemisinine combination therapy (ACT) and other new antimalarials by identifying opportunities and problems associated with ACT use, and evaluating the effectiveness, sustainability and cost-effectiveness of improvements in combination therapy delivery.

Specific objectives.

1.  Improving access. To evaluate alternative models of ACT delivery involving public sector providers, private facilities, retailers, community health workers and mothers/caretakers so as to maximise access to effective antimalarials for those who have malaria.

2.  Improving drug targeting. To determine the impact on antimalarial drug use and health outcomes of interventions to improve rational drug prescribing and dispensing, including use of rapid diagnostic tests, so as to minimise overdiagnosis of malaria and overprescription of antimalarials.

3.  Longitudinal studies. To determine the effect of ACTs, when administered as repeated treatments, on treatment incidence and side-effects

4.  Pharmacovigilance. To collect, collate and evaluate data on safety of widescale deployment of ACTs and other combinations in the target population, and look at safety in high risk groups (e.g. infants, especially HIV-coinfected patients).

5.  Quality. To develop sampling methods and simplified laboratory and field tests for rapid detection of fake ACTs entering the market.

6.  Policy. To collate, integrate and interpret data from consortium activities to maximize generalisability. To communicate promptly evidence arising from the consortium's findings in ways most useful to national and international policy-makers and practitioners.

Partner institutions: 28 partners conducting 14 projects in Uganda, Tanzania, Zanzibar, Malawi, Mozambique, Rep. of South Africa, Cameroon, Nigeria, Ghana, Laos and Afghanistan.

Danish partners: CMP and DBL

Projects in Uganda: 

Introducing rapid diagnostic tests (RDTs) into the public & private health sectors in Uganda: a randomized trial among drug shops to evaluate impact on anti-malaria drug use.

Lead Principal Investigator:

Dr. Anthony Mbonye, Assistant Commissioner of Health Services, Department of Community Health, Ministry of Health, P.O. Box 7272, Kampala, Uganda

Other major investigators:

Dr. Siân Clarke, Gates Malaria Partnership, London School of Hygiene and Tropical Medicine, 50 Bedford Square, London WC1B 3DP, UK

Dr.  Kristian Schultz Hansen, Researcher, Health economics, Institute of Social Medicine, Faculty of Health Sciences, Arhus University, 8000 Arhus, Denmark

Dr. Pascal Magnussen, Centre for Health Research and Development, Faculty of Life Sciences, University of Copenhagen, Denmark

The cost-effectiveness of home-based management of malaria using artemether- lumefantrine (Coartem^®): a comparative study in two areas of high and low malaria transmission in rural Uganda.

Lead Principal Investigator: Dr Richard Ndyomugyenyi, National Malaria control Coordinator, Ministry of Health, P.O. Box 7272, Kampala, Uganda

Other major investigators:

Dr. Siân Clarke, Gates Malaria Partnership, London School of Hygiene and Tropical Medicine, 50 Bedford Square, London WC1B 3DP, UK

Dr.  Kristian Schultz Hansen, Researcher, Health economics, Institute of Social Medicine, Faculty of Health Sciences, Arhus University, 8000 Arhus, Denmark

Dr. Pascal Magnussen, Centre for Health Research and Development, Faculty of Life Sciences, University of Copenhagen, Denmark

Aims of the act consortium these projects address

1.  Improving access.

To evaluate alternative models of ACT delivery involving public sector providers, private facilities, retailers, community health workers and mothers/caretakers so as to maximise access to effective antimalarial drugs for those who have malaria. 

2.  Improving drug targeting.

To determine the impact on antimalarial drug use and health outcomes of interventions to improve rational drug prescribing and dispensing, including use of rapid diagnostic tests, so as to minimise over-diagnosis of malaria and over-prescription of antimalarial drugs

Most malaria deaths occur within 48 hours of onset of symptoms, and in rural areas with poor access to health facilities, home management of malaria (HMM) can improve the timeliness of treatment and reduce malaria mortality by up to 50%. In order to maximize both coverage and impact, ACTs should be deployed in HMM programmes, as well as in formal health facilities. Up to 80% of malaria cases are treated outside the formal health sector and shops are frequently visited as the first (and in some cases only) source of treatment. Strategies to deploy ACTs in Africa thus also need to examine the role of shops in home management and to ensure that drugs sold are appropriate. The current practice of presumptive treatment of any febrile illness as malaria (both at health facilities and in the context of HMM) based solely on clinical symptoms without routine laboratory confirmation, results in significant over-use of antimalarial drugs. With ACT being a more costly regimen, it is important to be more restrictive in its administration and rapid diagnostic tests (RDTs) provide a simple means of confirming malaria diagnosis in remote locations lacking electricity and qualified health staff.  This study therefore proposes to evaluate the feasibility, acceptability, and cost-effectiveness of using RDTs to improve malaria diagnosis and treatment by two types of community-based providers: (a) community drug distributors and (b) local shops and pharmacies. The accuracy of RDTs, and the acceptability of this approach, will be evaluated in both low and high transmission areas.

Project start and end: March 2009 - February 2012

Budget: 1,659,963 USD

Contact person:

Dr Pascal Magnussen
MD, DTM&H, specialist in Tropical Medicine and Infectious Diseases DBL - Centre for Health Research and Development, Faculty of Life Sciences, University of Copenhagen  at pma @ life.ku.dk

Read more:  

• ACT Concortium's global webpage

 Projects on Access: 

• The cost-effectiveness of home-based management of malaria using artemether- lumefantrine (Coartem^®): a comparative study in two areas of high and low malaria transmission in rural Uganda. Specif website

• Introducing rapid diagnostic tests (RDTs) into the public & private health sectors in Uganda: a randomized trial to evaluate impact on antimalarial drug use. Specific website