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