Adherence to artemisinin-based combination therapies (ACTs) for malaria is important for
effective treatment. This thesis compares adherence to ACTs obtained in the public and private retail
sectors, describes an intervention to improve dispenser knowledge and patient adherence, and
addresses challenges of measuring patient adherence to ACTs.
A cluster randomised trial of a text message intervention targeted at dispensers in Accredited
Drug Dispensing Outlets (ADDOs) was conducted in Tanzania to improve provision of advice on
artemether-lumefantrine (AL) and as a result patient adherence. An observational study was also
conducted among patients obtaining AL from public health facilities. In a third study, smart blister packs
that recorded when pills were removed were used to assess the validity of self-report. Adherence was
measured as completion of all doses (“completed treatment”) and completion of each dose at the
correct time (“timely completion”).