Plain English Summary
Background and study aims
We are carrying out a study to assess the feasibility and acceptability of introducing malaria rapid diagnostic tests in privately-owned drug shops in Nigeria. About 100 drug shops will be surveyed and will be used as recruitment sites to conduct about 1500 customer surveys. Our goal is to assess the overall prevalence of malaria by conducting rapid diagnostic tests on individuals who are seeking malaria treatment at drug shops. We will also look at patients willingness to pay for the test, ways in which adherence to test results can be improved, and patients opinion of drug shop sellers as able to conduct the tests on people. The studys findings will inform the design of national plans for the rollout of rapid diagnostics tests into the private health care sector in Nigeria.
Who can participate?
The REMEDI study aims to recruit about 1500 customers seeking malaria drugs for themselves or an accompanying minor at about 100 participating drug shops that sell at least one type of anti-malaria drug.
What does the study involve?
At participating drug shops, customers will be approached when exiting the shop and asked to participate in the study. Those who are eligible and consent to participate will be randomly allocated to receive a malaria rapid diagnostic test either for free or for a small fee. The participant will then be administered a questionnaire during the time it takes to see a test result, usually about 15 minutes. Based on the test result, customers will be given advice on the appropriate use of their anti-malaria drug, as well as referral information for a nearby facility. A free course of the first-line anti-malaria drug will be given to all customers who test positive to ensure that they have the appropriate drug.
One day after enrolment and testing, customers phone numbers entered into an automated text messaging service will be randomized to either receive no text message, a text message with a general information message, or a text message with a specific information message. All text messages will involve a standard script that reminds the participant of their test result and appropriate drug treatment. The computer system will automatically conduct the randomization procedure.
Four days after enrolment and testing, a surveyor will conduct a phone interview with the participant to conduct a short survey assessing self-reported drug taking behaviour and other perceptions of the diagnostic test and drug vendors.
What are the possible benefits and risks of participating?
Participants will benefit by knowing whether or not they have malaria and provided with information about what to do with their anti-malarial drugs. For those who test positive, a free course of the first-line recommended drug will be provided.
The main risks associated with the study are a slight pain will be associated with the finger prick to obtain the blood sample for the test kit, and a chance that non-participants who have access to the participants mobile phone device may inadvertently receive the text message and discover the participants malaria status and participation in the study. To minimize these risks, text messages will not use any personally-identifying information.
Where is the study run from?
The study has been set up by the University of California, San Francisco with assistance from the Society of Family Health in Nigeria. 100 drug shops are in Karu Local Government Area in Nasarawa State.
When is the study starting and how long it is expected to run for?
It is anticipated that recruitment will start in October 2013. All participating drug shops will be enrolled in October 2013. Customer participants will be enrolled and followed up on an ongoing basis until about 15 December 2013.
Who is funding the study?
ExxonMobil Foundation. Once funding stops, data and samples collected during the study will be maintained by the University of California, San Francisco.
Who is the main contact?
Dr. Jenny Liu
Dr Jenny Liu
University of California
Global Health Sciences
50 Beale Street
United States of America
The REMEDI study Rapid Examination of Malaria and Evaluation of Diagnostic Information
The study will test the following hypotheses:
1. The prevalence of malaria in Nigeria is lower than popularly believed.
The null hypothesis is that the prevalence of malaria is similar to what is popularly believed.
2. Text message reminders of the test result and correct treatment will increase treatment adherence.
The null hypothesis is that text message reminders will have no effect on treatment adherence rates.
3. Individuals who pay for the diagnostic test will show higher treatment adherence compared to those who received the test for free.
The null hypothesis is that payment does not affect adherence rates.
4. Information specific to drug shop vendors in Nigeria delivering new malaria diagnostic tests will increase the acceptability of these sellers to conduct the test among their patrons.
The null hypothesis is that specific information will not have any differential effect on acceptability than general information.
1. National Health Research Ethics Committee of Nigeria (NHREC), Federal Ministry of Health, Abuja, 21 September 2013, ref: NHRED/01/01/2007-21/09/2013
2. Committee on Human Research, University of California, San Francisco, 17 September 2013, IRB# 12-09472, ref# 072086
Single site double-blind parallel-group study with two behavioral randomizations
Primary study design
Secondary study design
Randomised controlled trial
Patient information sheet
Not available in web format, please use the contact details below to request a patient information sheet
Diagnosis and appropriate treatment of malaria
The study will involve 1500 participants who will be followed-up 4 days after initial enrollment and testing to assess self-reported adherence (the recommended malaria treatment regimen is 3 days). There are two randomized components.
1. Randomization #1: Participants will be randomized to be either given the malaria rapid diagnostic test for free or for a small fee.
2. Randomization #2: One day after enrollment into the study, a text message reminder will sent to the mobile phone number provided by the participant. For participants who agreed to be tested with the malaria rapid diagnostic test at the time of enrollment, their phone numbers will be randomized to either receive no message vs. a text message with general information of the rapid diagnostic test availability in Nigeria vs. a text message with specific information of the rapid diagnostic test availability from drug shop vendors.
Primary outcome measures
Malaria rapid diagnostic test result measured at baseline
Secondary outcome measures
Assessed 4 days after enrollment and testing and will include:
1. Self-reported treatment with anti-malarial medication
2. Self-reported treatment with non-antimalarial medications
3. Perceptions of drug shop vendors ability to perform rapid diagnostic tests
4. Perceptions of rapid diagnostic tests in general
5. Cost effectiveness
6. Perceptions of the text message reminders
Overall trial start date
Overall trial end date
Participant inclusion criteria
1. Adult aged over 17 years and having purchased malaria drugs for either him/herself or an accompanying minor at an enrolled study site
2. Customers must be willing to be assigned to any of the study intervention groups
3. Participating drugs shops must sell at least one type of antimalarial drug
Target number of participants
Participant exclusion criteria
1. Pregnant women who are seeking malaria treatment for herself are excluded because the recommended treatment for malaria is a different drug regimen than one than the study can provide
2. Any individual seeking treatment for illnesses other than malaria
3. Any adult who is purchasing malaria for a minor and the minor is not present at the time of enrollment
4. Because the study involves a follow-up survey conducted via phone, participants who cannot provide at least one phone number at which they can be reached are excluded
5. Drug shops that do not sell antimalarial drugs are excluded
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
University of California, San Francisco
United States of America
University of California, San Francisco (USA)
c/o Mr. Regnier Jurado
Contracts and Grants
3333 California Street
United States of America
ExxonMobil Foundation (USA) (PO046342)
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Participant level data
Not provided at time of registration
Results - basic reporting