Washington D.C., USA, 22-27 July 2012 Lessons from the Rapid Response of Namibia’s Supply Chain...
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Washington D.C., USA, 22-27 July 2012www.aids2012.org
Lessons from the Rapid Response of Namibia’s Supply Chain When Antiretroviral Treatment
Guidelines Changed to Tenofovir-based First-line Regimens
J Lates,1 B Ongeri,2 A Wolde,2 E Sagwa,2 D Mabirizi2
1Ministry of Health & Social Services (MoHSS), Namibia2Partnership for Supply Chain Management System (PFSCM)
THPDE0101
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Background
• Namibia started ART services in 2003 & had rapid roll-out
• By Dec 2009 Namibia had 68,000 adults on ART; 53% AZT, 34% D4T, 11% TDF
• The Electronic Dispensing Tool was introduced in 2006 to optimise management of
ART patients and data
• Shortage of storage space for ARVS @ CMS & facilities was already being
experienced by 2008
• In 2010 national ART guidelines revised
– ART eligibility criteria changed CD4 ≤200 to ≤350
– Preferred 1st line regimen changed to TDF
• CMS had to rapidly increase stocks of TDF and minimise risk of wastage of
d4T and AZT products
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Methods
• Data on patient enrolment & CD4 levels of pre-ART patients was used to predict the impact of new ART guideline, especially on ARV supply chain and ARV expenditure
• Purchasing parameters changed to build up stocks of TDF products as a 3 fold increase in TDF demand was expected
• CMS warehouses were renovated to increase available racking to handle the increased volume of stocks
• Min & max stock levels in Health Facilities were revised down to 4 and 2 months respectively
•
• 3/12 reviews were initiated to monitor consumption trends & stock holdings and pro-actively ensure continuous availability
• Intensified tracking of regimen trends to monitor implementation of new guidelines & guidance on improvements to service provision made through quarterly feedback reports
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Results
• New guidelines additional costs estimated at US$ 3.3 million that Namibian Government pledged to cover
• Within 8/12 CMS had accumulated sufficient stock of TDF
• New national ART guidelines rolled out Sept 2010
• By Dec 2011 35% of adults on ART were using TDF- c.f. 11% at introduction of new ART guidelines
• No stock outs of TDF formulations were reported
Before 2010 ART Guideline Launch
[Jan-Mar 2010]
Immediately After 2010 ART Guideline
Launch [Oct-Dec 2010]
One-Year After 2010 ART Guideline Launch
[Oct-Dec 2011]
0%
20%
40%
60%
80%
100%
16%
64%
81%75%
25%14%
7% 4% 3%2% 6% 2%
ART regimens used by new adult patients before and after implementation of 2010 treatment guidelines
TDF-Based AZT-Based d4T-Based Others
Perc
ent o
n re
gim
en
Dec 2009 Dec 2010 Dec 20110%
20%
40%
60%
80%
100%
0
20,000
40,000
60,000
80,000
100,000
11% 20%35%
53%58%
50%34%
19% 11%2% 4% 4%
68,09080,349
92,782
ART regimens used in adults at end of 2009, 2010 and 2011
TDF-Based AZT-Based d4T-Based OthersNumber of Patients
Perc
ent o
n re
gim
en
Num
ber o
f adu
lt pa
tient
s
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Key success factors
Acknowledgements• Executive Management of the Ministry of Health and Social Services for leadership
and guidance
• Staff of the Central Medical Store and all Public Health Facilities for their untiring work in ensuring quality ART services despite their heavy workload
• Staff of the USAID funded SCMS and SIAPS projects who provide ongoing support to Pharmaceutical Services
• The people of the USA for their generous financial support
• Government funding commitment• Availability of accurate data on stock levels, patient numbers & regimens• Flexible procurement system• Integrated supply chain system