The procurement and supply chain strengthening project: Improving public health supply chains for better access to HIV medicines, Uganda 2011-2016

Abstract

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