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Acute Febrile IllnessAcceleratorNCT04081051

Advancing Access to Diagnostic Innovation Essential for UHC and AMR Prevention

A study testing diagnostic algorithm+Point of care rapid diagnostic tests+ Behavior change ( assessed together as a single package of interventions) in people with Acute Febrile Illness, run by Foundation for Innovative New Diagnostics, Switzerland at 8 sites in 5 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This study aims to evaluate clinical outcomes and antibiotic prescription patterns following the use of diagnostic algorithms, point of care (PoC) rapid diagnostic tests, and behaviour change interventions in cases of acute febrile illnesses in children, adolescents and adults presenting at out patient clinics in… Read more about this study

Who is it for?
Ages 6 months to 65 years
Conditions the study is for
Acute Febrile Illness
What is being tested?
diagnostic algorithm+Point of care rapid diagnostic tests+ Behavior change ( assessed together as a single package of interventions)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
17,294 participants
Where
8 sitesin 5 countries
Study dates
31 Aug 2020to 30 Sep 2022
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 6 months to 65 years
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Patients presenting with fever with no focus/RTI:
  • Children (6 months to <12 years) and adolescents (12 years to less than 18 years old) of both sexes .
  • Presenting with an acute febrile illness defined as temperature of >37.5°C or history of fever within the last 7 days with no focus or suspected RTI.
  • Parent/guardian providing written informed consent for their children if less than 18 years of age.
  • Obtain assent for adolescent between 12 and less than 18 years old
  • Willing to provide blood and other samples and adhere to study procedures explained in the consent forms following the protocol.
  • Available and willing to return for follow-up visit at the health facility on day 7 (+/- 2 days).

Who cannot join

  • o Children and adolescents from 6 months to less than 18 years old presenting with chronic febrile illness (fever lasting more than 7 days).
  • Patients with acute febrile illness outside the allowed age range for the site.
  • Severely ill patients requiring hospital admission or referral as assessed by the study clinicians.
  • Anyone refusing consent to the study or not able to attend the health centre for follow-up (adults, the children of parents/guardians, or adolescents who refuse or are missed when asking for consent).

Trial locations and contacts

8 sites in 5 countries.

8 sites in 5 countries

India4 sites
  • National Institute of Cholera & Enteric Diseases

    Beliaghata, Kolkata, 700010

  • Post Graduate Insitute Medical Education and Research

    Chandigarh, 160012

  • Jan Swathya Sahyog

    Ganiyari, Chhattisgarh, 495112

  • R D Gardi Medical College

    Ujjain, Madhya Pradesh, 456006

Other trials in India

Burkina Faso1 site
  • IRSS-DRCO/Clinical Research Unit of Nanoro (CRUN)

    Nanoro, BP 218

Other trials in Burkina Faso

Ghana1 site
  • Shai-Osudoku District Hospital

    Accra, Dodowa

Other trials in Ghana

Nepal1 site
  • Patan Academy of Health Sciences

    Lalitpur, Lagankhel, 44700

Other trials in Nepal

Uganda1 site
  • Infectious Disease research collaboration

    Kampala

Other trials in Uganda

About this study

Official title: Impact of Improved Diagnostic Tools, Training and Communication on Acute Fever Case Management and Antibiotic Prescriptions for Children and Adolescents Presenting at Outpatient Facilities in Lower & Middle-Income Countries.

This study aims to evaluate clinical outcomes and antibiotic prescription patterns following the use of diagnostic algorithms, point of care (PoC) rapid diagnostic tests, and behaviour change interventions in cases of acute febrile illnesses in children, adolescents and adults presenting at out patient clinics in lower and middle income countries. The study is to be implemented in 2 phases- the first run from 2020 to 2021 and the 2nd phase from 2021 to 2022 to include COVID-19 PoCTs.

Read the detailed description

Background and rationale. 'Just-in-case' antibiotic prescribing practices is one of the causes of inadequate management of 'acute febrile illnesses' and AMR in Low- and Middle-income Countries (LMICs). At the same time, some people who would require antibiotic treatment do not get it. An improvement in case management and prescription practice might lead to a decrease in morbidity and mortality. Success will mean making significant steps toward achieving the dual goal of improving UHC and tackling AMR.

The PICO question addressed is: in children/ adolescents and adults (Population) presenting to outpatient clinics / peripheral health centres in LMICs with acute febrile illness/Respiratory Tract Infection can a combination of available PoC rapid diagnostic tests, diagnostic aids/algorithms, clinic process flow and, training and communication (Intervention) improve management of acute febrile illnesses and better target the use of antibiotics / reduce unnecessary antibiotic prescriptions (Outcomes) compared to current practice (Control)?

Primary objective(s).

To evaluate the impact of a package of interventions (point of care [PoC] tests, clinical algorithm, clinic process flow, training and communication tools) on clinical outcomes and antibiotic prescriptions, with standard-of-care practices, in children and adolescents presenting with acute febrile illnesses (defined as fever with no focus or Respiratory Tract Infection lasting for no more than 7 days), at outpatient clinics.

Secondary objective(s)

  1. To improve the management of acute febrile illness
  2. To promote rational and targeted use of antibiotics for acute febrile illness
  3. To determine the aetiology of fever in patients presenting to outpatient facilities using available PoC diagnostic tests
  4. To study the safety and feasibility of a package of interventions compared to current practice of care
  5. To assess the effectiveness of training and communication tools to adherence to the prescribed treatment

Primary endpoints

  1. Proportion of outpatient cases of acute febrile illness with favourable outcome (defined as being alive and asymptomatic).
  2. antibiotic prescriptions rates for acute febrile illness in the clinic Secondary endpoints (outcomes) 1. Duration of time spent in the clinic
  3. Proportion of patients treated for specific bacterial infection 3. Proportion of patients with disease specific diagnosis identified by PoC tests 4. Frequency of serious adverse event (SAE) within 7 days of recruitment 5. Frequency of unscheduled (unplanned) visit within 7 days of recruitment 6. Training and communication package uptake 7. Proportion of patients prescribed antibiotic at clinic who reported adherence to prescription on day 7 8. Proportion of patients who were not prescribed antibiotics at clinic who received antibiotics elsewhere between day 0 and day 7 9. Behaviour Change Intervention Recommendations

Trial design: A multi-centre, open label, two arm, randomized-controlled trial

Trial sites: This study will be conducted in outpatient departments and primary care clinics in Burkina Faso, Ghana, India, Nepal and Uganda.

Trial population: The study population will consist of children, adolescents and adults presenting to the health care facility, or provider, with acute fever or history of fever

Sample Size: 19,922

Being tested
diagnostic algorithm+Point of care rapid diagnostic tests+ Behavior change ( assessed together as a single package of interventions)

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • diagnostic algorithm+Point of care rapid diagnostic tests+ Behavior change ( assessed together as a single package of interventions)Other

    Diagnostic algorithm utilizing pathogen specific and non-pathogen specific point of care, rapid diagnostic tests, behavioral change intervention for healthcare workers

Study groups in NCT04081051
Study groupRoleWhat they receive
InterventionExperimentalDiagnostic algorithm( paper and electronic) utilizing pathogen specific and non-pathogen specific point of care, rapid diagnostic tests, behavioral change training for healthcare workers
Receives: Other: diagnostic algorithm+Point of care rapid diagnostic tests+ Behavior change ( assessed together as a single package of interventions)
controlNo interventionStandard of care practices for acute febrile illness

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Proportion of acute febrile cases with favorable clinical outcomes at day 7

    Favorable defined as being alive and asymptomatic.

    Measured: Day 7

  2. Antibiotic prescription rates in acute fever cases

    Proportion of antibiotic prescriptions for acute febrile illness in the clinic

    Measured: Day 0

Secondary outcomes (4)
  1. Proportion of participants with acute fever Diagnoses identified by point of care tests.

    Proportion of patients with disease specific diagnosis identified by PoC tests

    Measured: Day 0

  2. Adverse events

    Frequency of adverse events within 7 days of recruitment

    Measured: Day 7

  3. Time spent in the clinic

    Time spent in the clinic

    Measured: Day 0

  4. Proportion of study participants who adhered to antibiotic prescriptions

    Adherence to antibiotic prescriptions

    Measured: Day 7

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted6 Sep 2019
  2. Study start31 Aug 2020
  3. Primary completion30 Sep 2022
  4. Study completion30 Sep 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Diagnosis
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
17,294 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04081051
Sponsor's protocol ID
AM 001
Acronym
Accelerator
Status last verified
Nov 2023
First submitted
30 Aug 2019
Last updated
5 Dec 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: to be discussed

Publications

  • Kaur M, Kumar D, Horgan P, Taneja N, Gahlot S, Kaur T, Tomar A, Singh S. Training and Communication Package for Acute Fever Case Management and Antibiotic Prescriptions: A Qualitative Exploration into Changing Behaviors of Healthcare Workers, Patients, and Caregivers in Chandigarh, India. Indian J Public Health. 2026 Apr 1;70(2):169-176. doi: 10.4103/ijph.ijph_482_25. Epub 2026 Jun 19.

    PubMed 42330228
  • Kiemde F, Nkeramahame J, Ibarz AB, Dittrich S, Olliaro P, Valia D, Rouamba T, Kabore B, Kone AN, Sawadogo S, Bere AW, Some DY, Some AM, Compaore A, Horgan P, Weber S, Keller T, Tinto H. Impact of a package of point-of-care diagnostic tests, a clinical diagnostic algorithm and adherence training on antibiotic prescriptions for the management of non-severe acute febrile illness in primary health facilities during the COVID-19 pandemic in Burkina Faso. BMC Infect Dis. 2024 Aug 27;24(1):870. doi: 10.1186/s12879-024-09787-y.

    PubMed 39192209
  • Adjei A, Kukula V, Narh CT, Odopey S, Arthur E, Odonkor G, Mensah MM, Olliaro P, Horgan P, Dittrich S, Moore CE, Salami O, Awini E, Nkeramahame J, Williams J, Baiden R. Impact of Point-of-Care Rapid Diagnostic Tests on Antibiotic Prescription Among Patients Aged <18 Years in Primary Healthcare Settings in 2 Peri-Urban Districts in Ghana: Randomized Controlled Trial Results. Clin Infect Dis. 2023 Jul 25;77(Suppl 2):S145-S155. doi: 10.1093/cid/ciad328.

    PubMed 37490745
  • Kiemde F, Valia D, Kabore B, Rouamba T, Kone AN, Sawadogo S, Compaore A, Salami O, Horgan P, Moore CE, Dittrich S, Nkeramahame J, Olliaro P, Tinto H. A Randomized Trial to Assess the Impact of a Package of Diagnostic Tools and Diagnostic Algorithm on Antibiotic Prescriptions for the Management of Febrile Illnesses Among Children and Adolescents in Primary Health Facilities in Burkina Faso. Clin Infect Dis. 2023 Jul 25;77(Suppl 2):S134-S144. doi: 10.1093/cid/ciad331.

    PubMed 37490742
  • Compaore A, Ekusai-Sebatta D, Kaawa-Mafigiri D, Kukula V, Odopey S, Kapisi J, Hopkins H, Kiemde F, Tinto H, Baiden R, Olliaro P, Nkeramahame J, Dittrich S, Horgan P; ADIP study group. Viewpoint: Antimicrobial Resistance Diagnostics Use Accelerator: Qualitative Research on Adherence to Prescriptions. Clin Infect Dis. 2023 Jul 25;77(Suppl 2):S206-S210. doi: 10.1093/cid/ciad323.

    PubMed 37490738
  • Salami O, Horgan P, Moore CE, Giri A, Sserwanga A, Pathak A, Basnyat B, Kiemde F, Smithuis F, Kitutu F, Phutke G, Tinto H, Hopkins H, Kapisi J, Swe MMM, Taneja N, Baiden R, Dutta S, Compaore A, Kaawa-Mafigiri D, Hussein R, Shakya SU, Kukula V, Ongarello S, Tomar A, Chadha SS, Walia K, Kelly-Cirino C, Olliaro P. Impact of a package of diagnostic tools, clinical algorithm, and training and communication on outpatient acute fever case management in low- and middle-income countries: protocol for a randomized controlled trial. Trials. 2020 Nov 25;21(1):974. doi: 10.1186/s13063-020-04897-9.

    PubMed 33239106

Questions about this trial

What is this clinical trial studying?

A study testing diagnostic algorithm+Point of care rapid diagnostic tests+ Behavior change ( assessed together as a single package of interventions) in people with Acute Febrile Illness, run by Foundation for Innovative New Diagnostics, Switzerland at 8 sites in 5 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 5 Dec 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 8 sites in India, Burkina Faso, Ghana, Nepal, Uganda. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Proportion of acute febrile cases with favorable clinical outcomes at day 7 (time frame: Day 7). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04081051, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 5 Dec 2023.

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