Community Interventions for Tackling Antimicrobial Resistance in Ghana (CITAR-Ghana)

The Pennsylvania State University (PENNSTATE)

Status: Begins enrollment in 1 month

Conditions: Upper Resp Tract Infection

Treatments: Behavioral: Legal Reminder; Behavioral: Individualized Feedback

Study type: Interventional

Funder types: Other

Identifiers

NCT07284914

102725 (Other Grant/Funding Number)

STUDY00026602

Details and patient eligibility

About

This research project aims to test the effect of two interventions targeted to community pharmacies in the Greater Accra region, Ghana, on antibiotics dispensing rates. The general goal is to inform the design of future policies to address the rising threat of antimicrobial resistance.

Full description

Interventions that discourage community pharmacies from providing antibiotics without proper diagnosis and a physician's prescription are critically needed in low- and middle-income countries in order to address the rising threat of antimicrobial resistance. In this study, we will test the effect of two interventions targeted to community pharmacies in the Greater Accra region of Ghana. We will conduct a baseline survey, followed by visits by standardized patients (SPs). We will then implement the interventions (described below) and assess the outcomes again using SPs.

The study has 4 key objectives:

Objective 1. Assess the effect of two behavioral interventions targeted to community pharmacies on antibiotics dispensing rates. We randomly assign 285 pharmacies in Greater Accra 1:1:1 into one of three arms: 1) Control, 2) Individualized Feedback, and 3) Legal Reminder. In the Individualized Feedback arm, we use information from the first visits to provide customized feedback to the pharmacies. In the Legal Reminder arm, we provide a letter from the Ghana authorities emphasizing that providing antibiotics without a physician prescription is against the law.

Objective 2. Assess the extent of know-do gap in antibiotics dispensing behavior among community pharmacies. We compare self-reported data from a baseline survey and the one obtained from SP visits to assess the gap between what the pharmacies know and what they do in practice.

Objective 3. Examine the effect of reduced pressure from patients for antibiotics on pharmacies' dispensing behavior. The two demand variations we will test are the following: 1) Patient asks for a medicine (normal demand pressure), 2) Patient explicitly says that they would prefer not to take antibiotics and mention that they do not have a physician prescription and that their condition appears to be viral (reduced demand pressure).

Objective 4. Assess differential effects of the two interventions and reduced demand pressure across patient's age.

Enrollment: 285 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion and exclusion criteria

Inclusion Criteria for community pharmacies:

• Operating within the Greater Accra region of Ghana
• Registered with Ghana Pharmacy Council
• "Stand-alone", i.e., not affiliated or next to a hospital

Exclusion Criteria:

• Operating only outside the Greater Accra region of Ghana
• Not registered with Ghana Pharmacy Council
• Hospital pharmacy

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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285 participants in 3 patient groups

Control

No Intervention group

Description:

No intervention

Individualized Feedback

Experimental group

Description:

Pharmacies receive customized feedback on their antibiotics dispensing behavior.

Treatment:

Behavioral: Individualized Feedback

Legal Reminder

Experimental group

Description:

Pharmacies receive letter from the authorities in Ghana emphasizing that providing antibiotics without a physician prescription is against the law.

Treatment:

Behavioral: Legal Reminder