System effectiveness of Artemether-Lumefantrine in Tanzania

Early case detection and prompt treatment with artemisinin-based combination therapy (ACT) is one of the main malaria control strategies. The INDEPTH Network Effectiveness and Safety Studies on Antimalarials in Africa (INESS) was implemented in 7 Health and Demographic Surveillance Sites to identify bottlenecks of the ACT efficacy decay. This presentation will share findings on the systems effectiveness of artemether lumefantrine (ALu) in the Rufiji and Kilombero-Ulanga (KU) HDSS sites in rural Tanzania. Household and health facility surveys were conducted in low and high transmission seasons to determine access to an official ACT provider within 24h of fever onset, provider compliance, patient adherence and therapeutic efficacy. Access to an official ACT outlet was observed to be 37% in Rufiji and 42% in KU. Provider compliance was found to be 75% in Rufiji and 60% in KU. 65% of the patients from Rufiji and 71% of patients from KU adhered to treatment. This resulted in an overall systems effectiveness of 18% in Rufiji and 17% in KU. Health system factors contributing to this loss are suboptimal access and provider compliance. Well-designed system interventions are needed to strengthen the identified weaknesses in order to improve the effectiveness of ACTs as a malaria control strategy.