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Abstract Background Pharmacies are popular first points of contact for mild infections in the community. Pharmacy services in many countries have expanded to include vaccines and point-of-care tests. In low- and middle-income countries like Vietnam, poor enforcement of regulations results in substantial volumes of over-the-counter antibiotic sales. Point-of-care tests could provide an economically viable way to reduce antibiotic sales, while still satisfying customer demand for convenient healthcare. C-reactive protein point-of-care testing (CRP-POCT) can reduce antibiotic prescribing for respiratory illness in primary care. Here we explore the acceptability and feasibility of implementing CRP-POCT in pharmacies in Vietnam. Methods We conducted a mixed-methods study between April and June 2021. A customer exit survey with 520 participants seeking acute respiratory infection (ARI) treatment at 25 pharmacies evaluated acceptability and willingness-to-pay (WTP) for CRP-POCT and post-service satisfaction. Factors driving customers’ acceptance and WTP were explored through mixed-effects multivariable regression. Three focus group discussions (FGDs) with customers (20 participants) and 12 in-depth interviews with pharmacists and other stakeholders were conducted and analysed thematically. Results Antibiotics were sold to 81.4% of patients with CRP levels below 10mg/L (antibiotics not recommended). 96.5% of customers who experienced CRP-POCT supported its future introduction at pharmacies. Patients with antibiotic transactions (aOR, 2.25; 95%CI: 1.13-4.48) and those suffering ARI symptoms for more than 3-days (aOR, 2.10; 95%CI: 1.08-4.08) were more likely to accept CRP-POCT, while customers visiting for children (aOR, 0.20; 95%CI: 0.10-0.54) and those with preference for antibiotic treatment (aOR, 0.45; 95%: 0.23-0.89) were less likely to accept CRP-POCT. 78.3% (95% CI, 74.8%-81.7%) of customers were willing to pay for CRP-POCT, with a mean of US$2.4 (±1.1). Customer’s income and cost of total drug treatment were associated with increased WTP. Enablers for implementing CRP-POCT included customers’ and pharmacists’ perceived benefits of CRP-POCT, and the impact of COVID-19 on perceptions of POCT. Perceived challenges for implementation included the additional burden of service provision, lack of an enabling policy environment, and potential risks for customers. Conclusions Implementing CRP-POCT at pharmacies is a feasible and well-accepted strategy to tackle the overuse of antibiotics in the community, with appeal for both supply and demand sides. Creating an enabling policy environment for its implementation, and transparent discussion of values and risks would be key for its successful implementation.

Original publication

DOI

10.1093/ofid/ofae445

Type

Journal article

Journal

Open Forum Infectious Diseases

Publisher

Oxford University Press (OUP)

Publication Date

02/08/2024