Abstract

Experience and confidence in health technologies: evidence from malaria testing and treatment in Western Kenya.

Indrani Saran¹, Judith Mangeni², Lucy Abel³, Steve Taylor⁴, Andrew Obala⁵, Wendy O'Meara⁶ (1)Boston College School of Social Work, (2)Moi University School of Public Health, (3)Academic Model Providing Access to Healthcare (AMPATH), (4)Duke Global Health Institute, Duke University , (5)Moi University School of Medicine, (6)Duke Global Health Institute, Duke University

APHA 2022 Annual Meeting and Expo

Context

Low adoption of effective health technologies increases illness morbidity and mortality worldwide. In the case of malaria, effective tools such as malaria rapid diagnostic tests (RDTs) and artemisinin-combination therapies (ACTs) are both under-used and used inappropriately. Individuals’ confidence in RDTs and ACTs likely affects the uptake of these tools, especially in places where many people seek treatment outside the formal health sector.

Methods
We followed a cohort of 36 households (280 individuals) in Western Kenya for 30 months starting in June 2017. During the study period, household members could request a free RDT from the study team any time they suspected a malaria illness, and positive RDT results prompted treatment with a free ACT. We conducted annual, monthly, and sick visit surveys to elicit beliefs about the accuracy of malaria RDT results and the effectiveness of ACTs. Beliefs were elicited on a 5-point Likert scale from “very unlikely to “very likely.

Results
Over the study period, the proportion of survey respondents that said a hypothetical negative RDT result was “very likely to be correct increased from approximately 55% to 75%. Moreover, controlling for initial beliefs, people who were tested with an RDT in the past year had 3.6 times higher odds (95% Confidence Interval (CI) [1 1.718 7.679], P=0.001) of saying a negative RDT was “very likely to be correct compared to those not tested. We also find evidence that these beliefs are associated with treatment behavior: those who believed a negative RDT was “very likely to be correct had 1.78 times higher odds (95% CI [1.079 2.934], P=0.024) of adhering to a negative RDT result (by not taking ACTs) than those who less certain about the accuracy of negative RDTs.

Conclusion and Discussion
Our results suggest that greater experience with RDTs can not only increase people’s confidence in their accuracy but also improve adherence to the test result. Lowering the barriers to testing thus would not only increase access to malaria RDTs thus potentially improving appropriate use of ACTs, but could also be beneficial in terms of community learning about the value of these new treatment technologies.