HIV Rapid Diagnostic Test Inventories in Zambézia Province, Mozambique: A Tale of 2 Test Kits

Abstract

Background: The first pillar of the UNAIDS 90-90-90 goal seeks to accurately identify persons living with HIV (PLHIV), a process that is predicated on facilities having the necessary HIV tests available to perform the task. In many rural settings, the identification of PLHIV is accomplished through a two-step process involving the sequential use of 2 separate rapid diagnostic tests (RDTs). Inadequate inventory of either test has ramifications for the success of HIV-related programs. The purpose of this study was to evaluate the inventory levels of HIV RDT kits at specific healthcare facilities in Zambézia province, Mozambique. Methods: Using facility-level pharmacy stock surveillance data from October 2015 through September 2016, we assessed the inventory levels of HIV RDTs at 75 health facilities in 8 districts within Zambézia province, Mozambique. Using programmatically established categories (good, sufficient, threatened, or stockout), defined in conjunction with the provincial health authorities, descriptive statistics were performed to determine inventory control of HIV RDTs at the district and health facility levels. Monthly proportions of adequate (good + sufficient) inventory were calculated for each district to identify inventory trends over the evaluation period. To assess whether the proportion of inadequate stocks differed between RDT, a mixed-effects logistic regression was conducted, with inadequate inventory status as the outcome of interest. Results: When viewed as a whole, the inventory of each test kit was reported as being at adequate levels more than 89% of the time across the 75 facilities. However, disaggregated analysis revealed significant variability in the inventory levels of HIV RDTs at the district level. Specifically, the districts of Inhassunge, Namacurra, and Pebane reported inadequate inventory levels (threatened + stockout), of one or both test kits, for more than 10% of the study period. In addition, a disparity between inventory levels of each test kit was identified, with the odds of reporting inadequate inventory levels of the confirmatory test (Uni-Gold™) being approximately 1.8-fold greater than the initial test (Determine™) (odds ratio: 1.82, 95% CI: 1.40-2.38). Conclusion: As Test and Treat programs evolve, a significant emphasis should be placed on the "test" component of the strategy, beginning with assurances that health facilities have the adequate inventory of RDT necessary to meet the needs of their community. As national policy-makers rely predominantly on data from the upstream arm of the supply chain, it is unlikely the disparity between inventory levels of HIV RDTs identified at individual districts and specific health facilities would have been recognized. Moving forward, our findings point to a need for (1) renewed efforts reinforcing appropriate downstream forecasting of essential medicines and diagnostic tests in general and for Uni-Gold™ test kits specifically, and (2) simple metrics that may be routinely collected at all health facilities and which may then easily and quickly flow upstream so that policy-makers may optimally allocate resources.

A Scoping Review of Supply Chain Management Systems for Point of Care Diagnostic Services: Optimising COVID-19 Testing Capacity in Resource-Limited Settings

“…The eligible studies were published between 2011 and 2021. The 31 articles included 15 reviews [ 10 , 12 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ], 1 website of an international organisation [ 33 ], 2 randomised controlled trials [ 34 , 35 ], 1 cross-sectional study [ 36 ], 1 case study [ 37 ], 1 cohort study [ 38 ] and 10 studies that used mixed method approaches ranging from focus group discussions to interviews to direct observations [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. The included articles presented evidence of research conducted in the following countries: Mozambique [ 34 , 36 , 44 ], Zimbabwe [ 49 ], Ghana [ 12 , 21 , 22 , 40 , 45 , 48 ], Malawi [ 42 ], Namibia [ 41 ], India [ 43 ], Sierra Leone [ 37 ], Burkina Faso [ 38 ], The Philippines [ ...…”

“…Evidence on the following POC diagnostic tests were provided: COVID-19 [ 27 , 28 , 33 ]; HIV [ 10 , 12 , 22 , 23 , 24 , 25 , 26 , 34 , 36 , 42 , 49 ]; malaria [ 10 , 12 , 22 , 23 , 34 , 35 , 38 , 40 , 41 , 43 , 44 , 46 , 47 , 48 ]; syphilis [ 10 , 12 , 23 , 32 , 34 , 39 , 42 , 45 ]; tuberculosis [ 30 , 31 ] and others comprising of anaemia [ 34 , 40 ], UTI [ 37 ], diabetes [ 12 , 31 ], blood glucose [ 22 ], preeclampsia urinalysis [ 37 ], urine pregnancy [ 22 ], urine protein [ 22 , 34 ], haemoglobin [ 22 ], dyslipidaemia […”

“…The eligible studies provided evidence on at least one aspect of the SCM system. The aspects of the SCM systems covered were procurement and stockouts [ 10 , 12 , 21 , 24 , 25 , 26 , 33 , 34 , 36 , 41 , 42 , 43 , 44 , 45 , 47 , 49 ], quality assurance [ 10 , 23 , 24 , 27 , 29 , 31 , 32 , 37 , 46 , 48 , 49 ], safe disposal [ 46 ], inventory management [ 10 , 12 , 21 , 25 , 35 , 36 ], selection [ 10 , 22 , 28 , 33 , 46 ], distribution [ 12 , 21 , 22 , 34 , 38 , 41 , 48 ], quantification [ 12 ], storage [ 12 , 21 , …”

“…The 15 studies that were appraised for methodological quality scored between 90% and 100%, which showed high methodological quality. Twelve studies scored the highest quality score of 100% [ 34 , 35 , 36 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 47 , 48 ]. One study scored 95% [ 38 ].…”

HIV supply chains in low- and middle-income countries: overview and research opportunities

“…Unfortunately, this is often not the case implying severe health issues (e.g., untimely treatment) (Braun et al, 2011). Frequently reported stock-outs of ARV drugs and test kits make it even more challenging for prevention of mother-to-child transmission programs to be successful (Braun et al, 2011;Gils et al, 2018;Wahlfeld et al, 2019).…”