Digitally Targeted Incentives for Malaria Case Management in Kenya

Last registered on August 16, 2021

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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

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published

October 27, 2020, 7:32 AM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Last updated

August 16, 2021, 5:55 PM EDT

Last updated is the most recent time when changes to the trial's registration were published.

Locations

Country

Kenya

Region

Primary Investigator

Name

Maria Dieci

Affiliation

UC Berkeley

Contact Primary Investigator

Other Primary Investigator(s)

PI Name

Paul Gertler

PI Affiliation

UC Berkeley

Contact Investigator

PI Name

Jonathan Kolstad

PI Affiliation

UC Berkeley

Contact Investigator

Additional Trial Information

Status

On going

Start date

2021-06-02

End date

2022-12-31

Keywords

Health

Additional Keywords

JEL code(s)

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

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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

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

A baseline survey of key pharmacy staff will be done in all study sites prior to the start of the study. Pharmacies will be onboarded to their assigned intervention arm and to the study beginning in July 2021 until the target number of enrolled sites have been reached. Outcomes data will be collected through the digital tools beginning in August 2021 and will continue until the end of the study period. Patient follow up surveys will occur in all study sites on a random sample of clients who seek care for fever/suspected malaria at study pharmacies during the intervention period. Random monitoring visits will occur in all study sites during the intervention period. A pharmacy endline survey will occur at the end of the intervention period.

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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