Digitally Targeted Incentives for Malaria Case Management in Kenya

Last registered on August 16, 2021

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
August 16, 2021, 5:55 PM EDT

Locations

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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
On going
Start date
2021-06-02
End date
2022-12-31
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
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. This study investigates the impact of differentially targeted incentives for malaria rapid diagnostic testing (RDT) and appropriate malaria treatments on RDT uptake and medication targeting. We use a novel digital platform designed for use in a network of private pharmacies in Kenya. We cross-randomize patient subsidies and pharmacy performance incentives and compare their effectiveness to each other and to the status quo in a cluster-randomized control trial. 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. 2021. "Digitally Targeted Incentives for Malaria Case Management in Kenya." AEA RCT Registry. August 16. https://doi.org/10.1257/rct.4705-4.0
Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)
The four intervention arms are as follows:
1. Control group: pharmacy is an active user of the basic sales and inventory management digital platform, and pharmacy manages own stock of malaria diagnostic tests and treatments
2. Patient subsidy group: In addition to the features present at control pharmacies, the clients who seek care for suspected malaria cases (for themselves or a household member present with them) will be eligible for a subsidized mRDT (90% subsidy) and a subsidized qualified ACT (80% subsidy) conditional on a confirmed positive malaria diagnosis. Pharmacies in this group will register all patients who elect to access these subsidies in the malaria case management digital platform
3. Pharmacy incentive group: In addition to the features present at control pharmacies, the pharmacies will receive an incentive to administer the mRDT (90 Kes), and an additional incentive to prescribe qualified ACTs to malaria-positive patients (80 Kes). Pharmacy staff will receive a 30 Kes incentive for recording transaction information in the malaria case management platform.
4. Combined group: In addition to the features present at control pharmacies, the clients are eligible for discounted mRDTs (60% subsidy) and discounted qualified ACTs conditional on a positive test result (60% subsidy). Pharmacies will receive an incentive to administer the mRDT (20 Kes), and an additional incentive to prescribe qualified ACTs to malaria-positive patients (15 Kes). Pharmacy staff will receive a 30 Kes incentive for recording transaction information in the malaria case management platform.
Intervention Start Date
2021-07-19
Intervention End Date
2021-12-31

Primary Outcomes

Primary Outcomes (end points)
The primary endpoints are uptake of malaria diagnostic tests (RDTs) and the proportion of ACTs that are sold to malaria-positive patients as measured through RDT result (appropriate treatment targeting).
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Other key endpoints are uptake of WHO-prequalified ACTs and the proportion of antimalarials that are sold to malaria-negative patients as measured through RDT result.
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
A sample of 180 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 pharmacy 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 pharmacy incentive and patient subsidy.
Experimental Design Details
Not available
Randomization Method
Stratified randomization will be conducted using the randtreat package in Stata 16.
Randomization Unit
Cluster-level randomization at the pharmacy level (stratified by lake endemic county, urbanicity, and malaria sales volumes)
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
180 pharmacies
Sample size: planned number of observations
14,400 eligible pharmacy clients (3,600 per arm)
Sample size (or number of clusters) by treatment arms
45 sites control, 45 sites patient subsidy, 45 sites pharmacy incentive, 45 sites hybrid patient subsidy & pharmacy incentive
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
With 180 pharmacies, and 80 eligible pharmacy clients with suspected malaria/site (and assuming that 80% of these clients receive an ACT), we expect to have a final sample of 14,400 individuals (3,600 per group). Assuming an intra-class correlation (ICC) of 0.16 for RDT uptake and 0.14 for ACT targeting, we will be able to detect a minimum of a 15-percentage point increase in each of our two main outcomes between each group.
Supporting Documents and Materials

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IRB

Institutional Review Boards (IRBs)

IRB Name
UC Berkeley Committee for Protection of Human Subjects
IRB Approval Date
2020-06-22
IRB Approval Number
2019-11-12739
IRB Name
Strathmore University Institutional Ethics Review Committee
IRB Approval Date
2020-04-02
IRB Approval Number
SU-IERC0609/19
Analysis Plan

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