Table 1 An overview of the challenges involved in ART drug supply management, proposed way forward and the ways in which operational research can guide future policie
From: Antiretroviral drug supply challenges in the era of scaling up ART in Malawi
Challenges | Way forward | Proposed operational research |
|---|---|---|
Increased number of different ARV formulations complicates the supply management system and increases the risk of stock outs | Keep the number of different ARV formulations as small as possible while maintaining adequate treatment options for the vast majority of patients | Cost-effectiveness studies comparing ART sites with large number of different ARVs and the national programme |
Correctly forecasting the proportion of patients in need of changing of ART regimen | Ensure that adequate alternative and second-line ARVs are available | Develop and test models that predict proportion of patients in need of substitution or switching ARV regimens Compare forecasting system based on patient numbers (ART clinic data) and ARV consumption (pharmacy data) in ART sites to decide which is the best predictor |
National stock positions that have decreased to two months of consumption lead to near stock outs in some ART clinics | Increase national stock positions to a minimum of six months’ consumption | Document the number of (near) stock outs after the establishment of the national buffer stock |
Storage capacity in health facilities is limited and undermines the quality of supply management | Increase frequency of deliveries to ART clinics from six monthly to three monthly Establish a national buffer stock | Document the number of (near) stock outs and the quantity of ARVs that expires |
ARV supply management is managed by a few individuals in the Ministry of Health | Hire/establish a dedicated full-time team for supply management for HIV commodities | Document the number of (near) stock outs |
Disbursement of grants is often interrupted | Increase national capacity to manage ARV supplies including reporting to donors Establishment of a fund that will lend monies to HIV programmes as suggested by the United Nations Foundation (‘Pledge Guarantee for Health’) | Document the timely release of funding by the main donor (The Global Fund) |