{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T21:51:22Z","timestamp":1792533082860,"version":"4.5.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"Supplement_2","license":[{"start":{"date-parts":[[2023,7,25]],"date-time":"2023-07-25T00:00:00Z","timestamp":1690243200000},"content-version":"vor","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009131","name":"Swiss Agency for Development and Cooperation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009131","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Increasing trends of antimicrobial resistance are observed around the world, driven in part by excessive use of antimicrobials. Limited access to diagnostics, particularly in low- and middle-income countries, contributes to diagnostic uncertainty, which may promote unnecessary antibiotic use. We investigated whether introducing a package of diagnostic tools, clinical algorithm, and training-and-communication messages could safely reduce antibiotic prescribing compared with current standard-of-care for febrile patients presenting to outpatient clinics in Uganda.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was an open-label, multicenter, 2-arm randomized controlled trial conducted at 3 public health facilities (Aduku, Nagongera, and Kihihi health center IVs) comparing the proportions of antibiotic prescriptions and clinical outcomes for febrile outpatients aged \u22651 year. The intervention arm included a package of point-of-care tests, a diagnostic and treatment algorithm, and training-and-communication messages. Standard-of-care was provided to patients in the control arm.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 2400 patients were enrolled, with 49.5% in the intervention arm. Overall, there was no significant difference in antibiotic prescriptions between the study arms (relative risk [RR]: 1.03; 95% CI: .96\u20131.11). In the intervention arm, patients with positive malaria test results (313\/500 [62.6%] vs 170\/473 [35.9%]) had a higher RR of being prescribed antibiotics (1.74; 1.52\u20132.00), while those with negative malaria results (348\/688 [50.6%] vs 376\/508 [74.0%]) had a lower RR (.68; .63\u2013.75). There was no significant difference in clinical outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This study found that a diagnostic intervention for management of febrile outpatients did not achieve the desired impact on antibiotic prescribing at 3 diverse and representative health facility sites in Uganda.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciad341","type":"journal-article","created":{"date-parts":[[2023,7,25]],"date-time":"2023-07-25T20:08:17Z","timestamp":1690315697000},"page":"S156-S170","source":"Crossref","is-referenced-by-count":13,"title":["Impact of the Introduction of a Package of Diagnostic Tools, Diagnostic Algorithm, and Training and Communication on Outpatient Acute Fever Case Management at 3 Diverse Sites in Uganda: Results of a Randomized Controlled Trial"],"prefix":"10.1093","volume":"77","author":[{"given":"James","family":"Kapisi","sequence":"first","affiliation":[{"name":"Department of Disease Surveillance, Infectious Diseases Research Collaboration , Kampala , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asadu","family":"Sserwanga","sequence":"additional","affiliation":[{"name":"Department of Disease Surveillance, Infectious Diseases Research Collaboration , Kampala , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Freddy Eric","family":"Kitutu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Makerere University School of Health Sciences , Kampala , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizeus","family":"Rutebemberwa","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Planning, and Management, Makerere University School of Public Health , Kampala , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phyllis","family":"Awor","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Planning, and Management, Makerere University School of Public Health , Kampala , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Weber","sequence":"additional","affiliation":[{"name":"Department of Statistics, ACOMED Statistics , Leipzig , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Keller","sequence":"additional","affiliation":[{"name":"Department of Statistics, ACOMED Statistics , Leipzig , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Kaawa-Mafigiri","sequence":"additional","affiliation":[{"name":"Social Work and Social Administration, Makerere University , Kampala , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Ekusai-Sebatta","sequence":"additional","affiliation":[{"name":"Department of Disease Surveillance, Infectious Diseases Research Collaboration , Kampala , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Horgan","sequence":"additional","affiliation":[{"name":"FIND , Geneva , Switzerland"},{"name":"Nuffield Department of Medicine, Big Data Institute, University of Oxford , Oxford , United Kingdom"},{"name":"Evidence & Impact Oxford , Oxford , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine","family":"Dittrich","sequence":"additional","affiliation":[{"name":"FIND , Geneva , Switzerland"},{"name":"Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford , Oxford , United Kingdom"},{"name":"Deggendorf Institute of Technology, European-Campus-Rottal-Inn , Pfarrkirchen , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catrin E","family":"Moore","sequence":"additional","affiliation":[{"name":"Nuffield Department of Medicine, Big Data Institute, University of Oxford , Oxford , United Kingdom"},{"name":"Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George's University of London , London , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olawale","family":"Salami","sequence":"additional","affiliation":[{"name":"FIND , Geneva , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piero","family":"Olliaro","sequence":"additional","affiliation":[{"name":"FIND , Geneva , Switzerland"},{"name":"Nuffield Department of Medicine, Pandemic Sciences Institute, University of Oxford , Oxford , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juvenal","family":"Nkeramahame","sequence":"additional","affiliation":[{"name":"FIND , Geneva , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi","family":"Hopkins","sequence":"additional","affiliation":[{"name":"Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine , London , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,7,25]]},"reference":[{"key":"2024022619264138200_ciad341-B1","author":"Global Action Plan on Antimicrobial Resistance"},{"key":"2024022619264138200_ciad341-B2","author":"Uganda: Antimicrobial Resistance National Action Plan 2018\u20132023"},{"key":"2024022619264138200_ciad341-B3","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis","volume":"399","author":"Antimicrobial Resistance Collaborators","year":"2022","journal-title":"Lancet"},{"key":"2024022619264138200_ciad341-B4","author":"GARP\u2014Uganda Situation Analysis"},{"key":"2024022619264138200_ciad341-B5","doi-asserted-by":"crossref","first-page":"178","DOI":"10.3390\/tropicalmed6040178","article-title":"Antimicrobial resistance situational analysis 2019\u20132020: design and performance for human health surveillance in Uganda","volume":"6","author":"Mugerwa","year":"2021","journal-title":"Trop Med Infect Dis"},{"key":"2024022619264138200_ciad341-B6","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0243868","article-title":"Antibiotic prescription practices among prescribers for children under five at public health centers III and IV in Mbarara district","volume":"15","author":"Okello","year":"2020","journal-title":"PLoS 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intensity","volume":"65","author":"Raouf","year":"2017","journal-title":"Clin Infect Dis"},{"key":"2024022619264138200_ciad341-B11","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1186\/s12936-020-03514-z","article-title":"Estimating malaria incidence from routine health facility-based surveillance data in Uganda","volume":"19","author":"Epstein","year":"2020","journal-title":"Malar J"},{"key":"2024022619264138200_ciad341-B12","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0016316","article-title":"Improved malaria case management through the implementation of a health facility-based sentinel site surveillance system in Uganda","volume":"6","author":"Sserwanga","year":"2011","journal-title":"PLoS One"},{"key":"2024022619264138200_ciad341-B13","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1186\/s13063-020-04897-9","article-title":"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","volume":"21","author":"Salami","year":"2020","journal-title":"Trials"},{"key":"2024022619264138200_ciad341-B14","article-title":"Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing: analysis of observational and randomised studies in public and private healthcare settings","volume":"356","author":"Hopkins","year":"2017","journal-title":"BMJ"},{"key":"2024022619264138200_ciad341-B15","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.4269\/ajtmh.16-0955","article-title":"The impact of introducing malaria rapid diagnostic tests on fever case management: a synthesis of ten studies from the ACT consortium","volume":"97","author":"Bruxvoort","year":"2017","journal-title":"Am J Trop Med Hyg"},{"key":"2024022619264138200_ciad341-B16","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-012973","article-title":"Improving prescribing practices with rapid 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A cross-sectional retrospective study","volume":"29","author":"Obakiro","year":"2022","journal-title":"J Glob Antimicrob Resist"},{"key":"2024022619264138200_ciad341-B25","doi-asserted-by":"crossref","first-page":"e799","DOI":"10.1016\/S2214-109X(20)30079-6","article-title":"Trends in reported antibiotic use among children under 5 years of age with fever, diarrhoea, or cough with fast or difficult breathing across low-income and middle-income countries in 2005\u201317: a systematic analysis of 132 national surveys from 73 countries","volume":"8","author":"Allwell-Brown","year":"2020","journal-title":"Lancet Glob Health"},{"key":"2024022619264138200_ciad341-B26","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.actatropica.2011.03.004","article-title":"Malaria in Uganda: challenges to control on the long road to elimination: I. 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