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

Abstract

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.

HIV viral suppression among pregnant and breastfeeding women in routine care in the Kinshasa province: a baseline evaluation of participants in CQI‐PMTCT study

“…Third, we did not collect data on drug stockouts during the study. It is possible that many of the women with unsuppressed viral load were simply not taking any medication at the time of the blood collection . Fourth, as mentioned earlier, DBS viral load systematically underestimates plasma viral load , suggesting that the true proportion of women with viral load ≥1000 copies/mL is likely underestimated.…”

“…However, selection of clinics supported by PEPFAR was not done randomly and because of the cross‐sectional design of the study, it is not possible to ascertain whether this association is a result of PEPFAR selecting clinics that are known to have the capacity to deliver better HIV care or the result of additional technical support to these clinics. Stockouts of HIV commodities including ART are common in health facilities across Kinshasa even when such commodities are available at local upstream warehouses . It is possible that the additional support from PEPFAR, through regular supervision is effective in reducing the impact of such stockouts on ART adherence.…”

Investigating the implementation of differentiated HIV services and implications for pregnant and postpartum women: A mixed methods multi-country study

“…In some settings, the expansion of ART programmes has exacerbated shortages of staff (Nachega et al, 2016), leading to overcrowded HIV clinics and long waiting times for patients attending for drug refills (Idindili et al, 2018). In other contexts, supply chains have not been able to keep up with increasing demands, leading to stock-outs of HIV test kits and antiretroviral drugs (Gils et al, 2018). These strains on the health system may undermine service quality, as overstretched healthcare workers struggle to keep up to date with newly revised protocols and procedures associated with evolving HIV treatment policies (Duncombe et al, 2015;Kwesigabo et al, 2012).…”

Predictors of Mortality among Adult People Living with HIV and Its Implications for Appointment Spacing Model Approach Care in Southwest Ethiopia.

“…Furthermore, studies conducted in Africa have revealed that factors affecting ART care are beyond individual level. The factors are related to health care institutions such as lack of ART trained health professionals (31)(32)(33)(34), and lack of quality care (35)(36)(37)(38); community level factors such as stigma (39,40) and traditional healing (41)(42)(43)(44); and program level factors such as political commitment (45,46) and lack of coordinated HIV care activities (47). Nevertheless, comprehensive study has not been carried out in Ethiopia to adequately address the challenges of ART care from the viewpoints of stakeholders.…”