Dealing with large-scale supply lines when introducing new regimens

Malati, Christine Y.; Rosenfeld, Joshua H.; Mowafy, Sherif Mohammed Said; Rittmiller, Trevor; Kuritsky, Joel N.; Crowley, John

doi:10.1097/coh.0000000000000387

Cited by 7 publications

(4 citation statements)

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“…In South Africa, facility stockouts also increased during introduction of TDF-3TC-EFV as a first-line regimen in 2013 and there was a national stockout of second-line regimens in 2015 due to unanticipated scale-up [ 30 ]. As such critical periods for the management of supply chains will continue to occur at introduction of new ART regimens, the need for engagement of all actors, extensive supply planning and firm orders has been suggested [ 31 , 32 ]. In DRC, introduction of rapidly changing WHO recommendations for superior drug regimens needs to be accompanied by similar preparation.…”

Section: Discussionmentioning

confidence: 99%

Stockouts of HIV commodities in public health facilities in Kinshasa: Barriers to end HIV

et al. 2018

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Stockouts of HIV commodities increase the risk of treatment interruption, antiretroviral resistance, treatment failure, morbidity and mortality. The study objective was to assess the magnitude and duration of stockouts of HIV medicines and diagnostic tests in public facilities in Kinshasa, Democratic Republic of the Congo. This was a cross-sectional survey involving visits to facilities and warehouses in April and May 2015. All zonal warehouses, all public facilities with more than 200 patients on antiretroviral treatment (ART) (high-burden facilities) and a purposive sample of facilities with 200 or fewer patients (low-burden facilities) in Kinshasa were selected. We focused on three adult ART formulations, cotrimoxazole tablets, and HIV diagnostic tests. Availability of items was determined by physical check, while stockout duration until the day of the survey visit was verified with stock cards. In case of ART stockouts, we asked the pharmacist in charge what the facility coping strategy was for patients needing those medicines. The study included 28 high-burden facilities and 64 low-burden facilities, together serving around 22000 ART patients. During the study period, a national shortage of the newly introduced first-line regimen Tenofovir-Lamivudine-Efavirenz resulted in stockouts of this regimen in 56% of high-burden and 43% of low-burden facilities, lasting a median of 36 (interquartile range 29–90) and 44 days (interquartile range 24–90) until the day of the survey visit, respectively. Each of the other investigated commodities were found out of stock in at least two low-burden and two high-burden facilities. In 30/41 (73%) of stockout cases, the commodity was absent at the facility but present at the upstream warehouse. In 30/57 (54%) of ART stockout cases, patients did not receive any medicines. In some cases, patients were switched to different ART formulations or regimens. Stockouts of HIV commodities were common in the visited facilities. Introduction of new ART regimens needs additional planning.

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Section: Discussionmentioning

confidence: 99%

Stockouts of HIV commodities in public health facilities in Kinshasa: Barriers to end HIV

et al. 2018

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“…This highlights that hospital social hierarchy is not unique to resource‐limited settings; however, the overarching concerns from nurses and physicians about ongoing availability of supplies upon completion of the research study stress a unique challenge faced by clinicians in resource‐limited settings. Supply chain issues are thoroughly described in the vaccine and HIV literature , and given INSN providers’ personal experience with supply shortages, it is not surprising they identified this potential barrier. This serves as an important reminder for those leading implementation efforts in resource‐limited settings to ensure a reliable supply chain both during and after initial deployment of technology.…”

Section: Discussionmentioning

confidence: 99%

Key considerations prior to nasal high flow deployment in a Peruvian PICU from providers’ perspectives

Ellington

Jacob‐Files²,

Becerra

et al. 2018

Acta Paediatrica

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Aim: Implementation of healthcare interventions in resource-limited settings remains challenging. This exploratory qualitative study describes social and institutional factors to consider prior to nasal high flow deployment in a middle-income country.Methods: Researchers conducted eight nursing focus groups and four semi-structured physician interviews at Instituto Nacional de Salud del Niño in Lima, Peru. Participants were identified via purposive sampling. Data were transcribed, translated and coded using a rigorous and iterative process. Pertinent themes were identified using thematic analysis with Dedoose software.Results: Thirty-nine nurses and four physicians participated in focus groups and interviews, respectively. Participants identified five major factors: (i) Adequate training, (ii) Clinician buy-in, (iii) Resource-limited setting, (iv) Local social context and (v) Organizational change management. To create buy-in, physicians and nurses emphasised the need to recognise benefit of the intervention and agree with clinical practice standardization. Physicians and nurses described barriers specific to resource-limited settings, including unreliable supply chain, whereas nurses shared concerns about increasing workload and physician-nurse social hierarchy. Participants recognised the importance of team commitment and ongoing interdisciplinary communication for sustainability.Conclusion: While some factors to consider prior to deployment of healthcare technology are universal, resource-limited settings have unique implementation barriers.

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“…Sin embargo, en nuestro país se debe tener en cuenta que el costo creciente de los medicamentos antirretrovirales aumenta el gasto del tratamiento en pacientes con VIH, y que en los cambios de tratamiento puede haber una variación considerable del valor, no solo de manejo sino de seguimiento. Con lo anterior, se debe evaluar constantemente la dinámica que tendrá la fabricación de nuevos antirretrovirales, y la aplicación en la transición a los países con diferentes ingresos per cápita [26].…”

Section: Análisisunclassified

Complejidad de la transición de los esquemas antirretrovirales en un programa de atención de VIH en Bogotá durante el periodo de 2015-2017

Arévalo-Mora¹,

Moscoso²,

Acosta³

et al. 2019

Rev. Colomb. Cienc. Quím. Farm.

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Cuando se decide cambiar una terapia antirretroviral se puede llegar a limitar futuras opciones‚ y es allí donde las conductas del personal tratante deben ser las más acertadas. Se realizó un estudio transversal-descriptivo‚ revisando las principales causas de cambios de esquema en los pacientes VIH de la IPS CEPAIN de Bogotá (Colombia) durante el periodo 2015-2017. Los cambios de tratamiento se estimaron en 8,1%; 8,8% y 5,8% durante los 3 años, el principal motivo de cambio fueron las reacciones adversas con 53,1%; 46%, y 49,6% respectivamente‚ seguidos de simplificación con 17,5; 25,1 y 26,5% y fracaso terapéutico en 19,8; 20,9 y 14,8% para cada año. Durante el primer año de tratamiento existió la necesidad de cambiar los esquemas en 12,9; 18,5, y 7,6% de los pacientes que iniciaron tratamiento en esos respectivos años. Las decisiones en los cambios de tratamiento antirretroviral involucran la introducción de nuevos antirretrovirales, la necesidad de reducir el número de tabletas o medicamentos, distintos perfiles de eficacia, tolerancia, efectos secundarios, toxicidad, barrera genética e interacciones. Otros factores a tener en cuenta son: el costo creciente de los medicamentos antirretrovirales, la dinámica en la transición y aplicación de los nuevos esquemas para garantizar un enfoque clínico, y económico sustentable.

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Dealing with large-scale supply lines when introducing new regimens

Abstract: Extensive planning and accounting for supply chain factors is essential to ensuring a smooth transition to a new regimen and to enable the global antiretroviral market to respond adequately.

Cited by 7 publications

References 1 publication

Stockouts of HIV commodities in public health facilities in Kinshasa: Barriers to end HIV

Stockouts of HIV commodities in public health facilities in Kinshasa: Barriers to end HIV

Key considerations prior to nasal high flow deployment in a Peruvian PICU from providers’ perspectives

Complejidad de la transición de los esquemas antirretrovirales en un programa de atención de VIH en Bogotá durante el periodo de 2015-2017

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