Background: Economic theory and limited empirical data suggest that costs per unit of HIV prevention program output (unit costs) will initially decrease as small programs expand. Unit costs may then reach a nadir and start to increase if expansion continues beyond the economically optimal size. Information on the relationship between scale and unit costs is critical to project the cost of global HIV prevention efforts and to allocate prevention resources efficiently.

A 'hybrid' intervention combining CTX prophylaxis followed by HAART would generate savings to a Ugandan company. Governments and other donors may find opportunities to share costs with the private sector as part of their phase-in strategy for antiretroviral therapy.

Background With countries moving towards reaching the UNAIDS 90-90-90 goal to achieve HIV epidemic control, there are going to be an unprecedented number of persons who will need to be tested, treated, and regularly monitored for viral suppression. However, most of the countries with the greatest burden of HIV/AIDS experience regular stock outages which could be detrimental to reaching these targets. ART and other commodities such as HIV test kits and laboratory supplies need to be readily and consistently available to achieve these targets. The main objective was to improve access to HIV/AIDS related commodities and strengthening institutional capacity for the management of HIV/AIDS logistics services through the MAUL procurement and supply chain strengthening project (PSSP) that rolled out four interventions on mentorship and support supervision, stock level monitoring, spatial visualization of stock indicators using GIS, and using WhatsApp to submit order reports as photo images. Methods Medical Access Uganda Limited, a private-not-for-profit supply chain management company in Uganda, implemented these interventions as part of a procurement and supply chain strengthening project (PSSP). These interventions were evaluated using performance monitoring indicators from 2011–2016. We tested for the significance in the change in scores of performance monitoring indicators using the test for difference in proportions. Health facilities were scored on 6 categories and accredited as bronze, silver or gold based on their total scores. Kaplan–Meier estimates were computed for time to silver, and gold ranking and univariate and multivariate Cox proportional hazards models were computed for time to gold ranking. Results We observed a significant reduction in reported stock-outs from 46 to 4% (p < 0.001) in the analysis period. Accurate stock card inventory rose from 79 to 91% (p < 0.001); adequate stock levels rose from 54 to 71% (p = 0.002) and stock reporting rates from 91 to 100% (p < 0.001). The stock order fill rate improved from a high of 93% to 97% (p = 0.375). Patient load (medium vs low adjusted hazard ratio (aHR): 2.19, p = 0.026; high vs low aHR: 2.97, p = 0.034) and number of support supervision visits (6–10 aHR: 3.33, p = 0.024; > 10 aHR: 5.78, p = 0.003) were associated with better stock management ranking scores. Conclusions Improvements in supply chain management in countries committed to achieving the 90-90-90 goals are crucial to achieving HIV epidemic control. Health system strengthening and mentorship investments in Uganda were feasible and are essential for sustainable disease control efforts.

With countries moving towards reaching the UNAIDS 90-90-90 goal to achieve HIV epidemic control, there are going to be an unprecedented number of persons tested, treated, and regularly monitored for viral suppression. However, most of the countries with the greatest burden of HIV/AIDS experience regular stock outages which could be detrimental to reaching these targets. Antiretroviral therapy and other commodities such as HIV test kits and laboratory supplies need to be readily and consistently available in order to achieve these targets. Medical Access Uganda Limited implemented several interventions as part of a procurement and supply chain strengthening project with the ultimate goal of supply chain improvement for access to HIV medicines. These interventions were evaluated using performance-monitoring-indicators from 2011-2016. We tested for the significance in the change in scores of performance-monitoring-indicators using the test for difference in proportions.Health facilities were scored on six categories and accredited as bronze, silver, or gold based on their total scores. Kaplan Meier estimates were computed for time to silver and gold ranking and Cox proportional hazards models were computed for time to gold ranking. The 13 sites with a baseline score <50 achieved a final score of (Unranked=0,Bronze(50-69)=2,Silver(70-89)=8,Gold(≥90)=3), 44 sites with a baseline score 50-69 achieved a final score of (U=0,B=0,S=26,G=18), 106 sites with a baseline score 70-89 achieved a final score of (U=0,B=3,S=62,B=41) and 31 sites with a baseline score ≥90 achieved a final score of (U=0,B=1,S=10,G=20). We observed a significant reduction in reported stock outs from 46%-4% (p<0.001). Accurate stock card inventory rose from 79%-91% (p<0.001); adequate stock levels from 54%-71% (p=0.002) and stock reporting rates from 91%-100% (p<0.001). The stock order fill rate improved from 93%-97% (p=0.375). Patient load (medium vs low adjusted hazard ratio (aHR):2.19,p=0.026; high vs low aHR:2.97,p=0.034) and number of support supervision visits (6-10 aHR:3.33,p=0.024; >10 aHR:5.78,p= 0.003) were associated with better stock management ranking scores. Improvements in supply chain management in countries committed to achieving the 90-90-90 goals are crucial to achieving HIV epidemic control. Health system strengthening and mentorship investments in Uganda were feasible and are essential for sustainable disease control efforts. RFSOs