Ensuring ARV Availability at Botswana’s Last Mile

The country’s Ministry of Health and Wellness (MOHW) and Central Medical Store (CMS) are working closely with the USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) project to improve availability of HIV/AIDS medicines all the way down to the health facility level.

The country is currently transitioning between treatments for HIV/AIDS, including the introduction of new ARVs and optimized treatment approaches for children. Properly implementing these programmatic changes will depend on a highly functional health supply chain and require a robust and accurate process for forecasting and supply planning (FASP).

Starting in July 2018, GHSC-PSM and the MOHW conducted several FASP workshops. During the first workshop, stakeholders and partners including USAID, CDC and others worked with the MOHW to enumerate ARV needs as well as plan for anticipated changes to ARV treatment. The workshop took place over the course of two weeks in Gaborone. Seven key staff members from the MOHW and CMS had been trained prior to the quantification exercise using the latest commodity quantification and costing software–Quantimed and PipeLine. With training from GHSC-PSM, the staff could actively contribute and use the tools during the ARV quantification exercise. The subsequent workshops that followed the two-week meeting improved on the previous quantifications and led to adjustments in ARV transition plans.

Ensuring availability of TLD: By September 2019, Botswana had 98.8 percent availability of the optimized treatment regimen TLD (tenofovir/lamivudine/dolutegravir) at its health facilities. This is one of the highest availability rates among countries that have started the transition to TLD.

Shifting patients to new and optimized ARVs: By July 2019, Botswana started the second phase of ARV transition by shifting patients away from legacy ARVs including nevirapine, efavirenz and lopinavir/ritonavir to TLD. The country also started shifting children to more suitable and effective ARV formulations.

Improving and institutionalizing data use for decision making: Building off the collaborative data analysis conducted during the FASP workshops, the MOHW and stakeholders meet monthly and make regular decisions on the quantity and timing of shipments. This is crucial in ensuring adequate stock levels for ARVs while avoiding stockouts and overstocks, which increases risk for expiry and wastage.

In April 2019, GHSC-PSM organized another workshop to review the ARV FASP and TLD transition plans that were developed eight months earlier. Participants made adjustments to accommodate changes and deviations from the original plans. It also brought the necessary parties together to agree on next steps for optimizing ARV treatment for children based on new recommendations from the World Health Organization. The April workshop allowed Botswana to adopt these recommendations and prepare a concrete action plan to implement them. With this plan in place, children will receive more effective ARV treatments with less toxicities and better treatment outcomes.

The FASP technical assistance provided by GHSC-PSM in Botswana has been instrumental in ensuring adequate ARVs are available to patients, especially during critical changes which optimize treatment approaches for adults and children living with HIV. With better planning and quantification for medicines and HIV/AIDS commodities, people in Botswana are living healthier lives.