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Digitally Targeted Incentives for Malaria Case Management in Kenya
Last registered on November 11, 2020

Pre-Trial

Trial Information
General Information
Title
Digitally Targeted Incentives for Malaria Case Management in Kenya
RCT ID
AEARCTR-0004705
Initial registration date
October 23, 2020
Last updated
November 11, 2020 2:30 PM EST
Location(s)

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Primary Investigator
Affiliation
UC Berkeley
Other Primary Investigator(s)
PI Affiliation
UC Berkeley
PI Affiliation
UC Berkeley
Additional Trial Information
Status
In development
Start date
2020-11-16
End date
2022-12-31
Secondary IDs
Abstract
We investigate the impact of targeted subsidies and incentives for malaria rapid diagnostic testing (RDT) and treatment on demand, sales and stocking decisions, and patient health outcomes, using a novel digital platform in Kenya. We propose a two-phased randomized trial to evaluate the effectiveness of patient subsidies and provider performance incentives on uptake of RDTs and medication targeting in private sector Kenyan pharmacies. The first phase will test four patient subsidies for RDTs and diagnosis-conditional subsidies for qualified ACTs (compared to no subsidy) in an RCT with interventions assigned at the patient level in a sample of eligible pharmacies. In a second phase, we will introduce patient subsidies and pharmacist/attendant performance incentives and compare their effectiveness to each other and to the status quo in a cluster-randomized control trial, with interventions at the pharmacy level. Our findings will contribute to the literature on the use of subsidies, performance incentives, and digital technology on targeted treatments.
External Link(s)
Registration Citation
Citation
Dieci, Maria, Paul Gertler and Jonathan Kolstad. 2020. "Digitally Targeted Incentives for Malaria Case Management in Kenya." AEA RCT Registry. November 11. https://doi.org/10.1257/rct.4705-1.1.
Experimental Details
Interventions
Intervention(s)
Intervention Start Date
2020-11-16
Intervention End Date
2021-08-31
Primary Outcomes
Primary Outcomes (end points)
The primary endpoints are uptake of malaria diagnostic tests (RDTs) and WHO-prequalified ACTs in pharmacies.
Primary Outcomes (explanation)
Secondary Outcomes
Secondary Outcomes (end points)
Other key endpoints are the proportion of malaria-positive patients that take ACTs (appropriate treatment targeting) and the proportion of malaria-negative patients that take ACTs (over-treatment).
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
Phase 1: A sample of 60 pharmacies that are active users of a digital sales/inventory management platform will be selected from malaria-endemic areas in Kenya. Patients who seek care at participating pharmacies will be randomized into one of four possible subsidy groups or a control group which receives no subsidy for RDTs and qualified ACTs. Subsidies on qualified ACTs are conditional on a positive malaria diagnosis by RDT.

Phase 2: A sample of 200 eligible pharmacies in malaria-endemic areas in Kenya will be randomized into one of four study arms: (1) a control group, (2) a patient subsidy group, which offers subsidized prices for RDTs and qualified ACTs, (3) a performance incentive group, which provides small financial incentives to pharmacists/attendants for adhering to malaria clinical guidelines when making treatment recommendations to clients, and (4) a hybrid group, which includes both the performance incentive and patient subsidy.
Experimental Design Details
Not available
Randomization Method
Randomization is done by random number generator.
Randomization Unit
Phase 1: individual-level randomization for subsidy levels for RDTs and qualified ACTs.
Phase 2: cluster-level randomization at the pharmacy level
Was the treatment clustered?
Yes
Experiment Characteristics
Sample size: planned number of clusters
Phase 1: 12,000 individuals (not clustered)
Phase 2: 200 pharmacies
Sample size: planned number of observations
Phase 1: 12,000 individuals Phase 2: 12,000 individuals
Sample size (or number of clusters) by treatment arms
Phase 1: 2400 individuals control (no subsidy offer), 2400 individuals high RDT + high ACT subsidy offer, 2400 individuals high RDT + low ACT subsidy offer, 2400 individuals low RDT + high ACT subsidy offer, 2400 individuals low RDT + low ACT subsidy offer.

Phase 2: 50 sites control, 50 sites patient subsidy, 50 sites performance incentive, 50 sites hybrid patient subsidy & performance incentive
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
Strathmore University Institutional Ethics Review Committee
IRB Approval Date
2020-04-02
IRB Approval Number
SU-IERC0609/19
IRB Name
UC Berkeley Committee for Protection of Human Subjects
IRB Approval Date
2020-06-22
IRB Approval Number
2019-11-12739