Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: A Cluster-randomised Trial of Health Worker and Community Interventions to Improve Adherence to National Guidelines for the Use of ACTs in Tanzania
Brief Summary: Background.

Overdiagnosis of malaria is widespread in health facilities throughout Africa, a situation that is unsustainable given the relatively high cost of artemisinin combination therapy (ACTs) compared to older antimalarials. In addition it often denies patients treatment for their actual illness and generates unreliable data for health planners. For these reasons the National Malaria Control Programme introduced revised guidelines for malaria diagnosis and treatment in 2006 restricting the recommendation for antimalarial treatment in patients over the age of 5 years to those with a positive blood slide or malaria rapid diagnostic tests (RDTs) result. To support this, RDTs will be introduced into primary care health facilities in Tanzania starting in 2009.

The high accuracy of current rapid diagnostic tests (RDTs) provides the potential for a cost-effective solution to the problem of malaria overdiagnosis. However, RDTs with revised guidelines to restrict malaria diagnoses to RDT-positive patients have been unsuccessful unless accompanied by unsustainable levels of supervision and training.

Primary objective.

To conduct a trial of interventions directed at prescribers or prescribers and communities compared to control groups to improve adherence to national guidelines for prescription of antimalarial treatment when supported by RDTs in primary health care facilities in NE Tanzania.

Methods

All 60 participating health facilities will receive RDTs and basic training in their use and a copy of current NMCP/MOH guidelines for each prescribing staff member. A health worker intervention arm will, in addition, receive workplace-based interactive training and messages from senior staff A health worker-community arm will receive the same training as the health worker arm and in addition leaflets will be provided to RDT-tested patients providing information on the test and the treatment given. All training materials will be approved by NMCP in Tanzania as being consistent with current national guidelines but with the addition that prescribers will be asked to follow RDT results in prescribing for patients of any age This policy is in line with the most recent revision to WHO guidelines and is supported by NMCP in Tanzania.

Study outcomes will be recorded through a 40% (2 days per week) exit survey of patients. Anthropological and economics studies will assess the costs and acceptability of interventions.


Options:
A: Arm Label: Control; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: Control | Arm Label: HW; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: HW | Arm Label: HWC; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: HWC | Intervention Type: BEHAVIORAL; Name: Control; Assigned to Arm(s): Control | Intervention Type: BEHAVIORAL; Name: HW; Assigned to Arm(s): HW | Intervention Type: BEHAVIORAL; Name: HWC; Assigned to Arm(s): HWC
B: Arm Label: CRM training of surgical teams; Type: N/A; Interventions: Other: Diffusion of a surgical safety checklist | Arm Label: No CRM training of surgical teams; Type: N/A; Interventions: N/A | Intervention Type: OTHER; Name: Diffusion of a surgical safety checklist; Assigned to Arm(s): CRM training of surgical teams
C: Arm Label: Arm 1; Type: EXPERIMENTAL; Interventions: Behavioral: Information feedback | Arm Label: Arm 2; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: Information feedback | Intervention Type: BEHAVIORAL; Name: Information feedback; Assigned to Arm(s): Arm 1 | Intervention Type: BEHAVIORAL; Name: Information feedback; Assigned to Arm(s): Arm 2
D: Arm Label: Educational multifaceted intervention; Type: EXPERIMENTAL; Interventions: Other: Multidisciplinary and multifaceted educational intervention. | Arm Label: Control; Type: NO_INTERVENTION; Interventions: N/A | Intervention Type: OTHER; Name: Multidisciplinary and multifaceted educational intervention.; Assigned to Arm(s): Educational multifaceted intervention

Answer: A