Aligning Angola’s Demand for HIV/AIDS Commodities Through a National Quantification of HIV/AIDS Requirements

Patient Access to Antiretroviral Medications Is Critical

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Date

January 30, 2018

People living with HIV/AIDS rely on regular access to antiretroviral (ARV) medications to suppress the amount of human immunodeficiency virus in their blood — or their “viral load.” A low viral load signifies that a person’s immune system is working to keep their HIV in check and limiting transmission to reach epidemic control.

In Angola, the Ministry of Health’s National Institute in the Fight against AIDS (INLS) works diligently to maintain sufficient levels of ARV stock in the country’s health facilities where clients access treatment and receive medications.

Despite these efforts, Angola has experienced times when 1) facilities have limited or incomplete regimens to dispense to patients, leading to stockouts; 2) stock stored at central and provincial warehouses is not transferred to health facilities in a timely way, leading to delayed treatment for patients on ARVs; and 3) commodities stored past their recommended shelf life are no longer usable, leading to overstock.

For example, in January 2017, nine President’s Emergency Fund for AIDS Relief (PEPFAR)-focused health facilities experienced a stockout of pediatric lopinavir/ ritonavir oral solution, limiting the use of oral solutions for pediatric regimens.

As a result of the exercise, team members concluded that they could lower the number of different types of ARVs from 26 to 17, the number of adult ARVs from 25 to 8, and the number of pediatric ARVs from 18 to 5.

Accurate Forecasting of Commodities Needed

To address these stockouts, and based on a request from INLS, representatives from INLS, USAID’s Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) project, the United Nations Development Program, and other partners met in spring 2017 to conduct a quantification exercise. The goal was to accurately forecast the number of HIV/AIDS rapid test kits (used to detect the presence of HIV in blood serum) and ARVs needed in the country over a 12-month period.

To lay the groundwork, GHSC-PSM staff provided advocacy at all levels and disseminated “weekly snapshots” to national and provincial Ministry of Health focal points and implementing partners to share information on current stock status in the country, in each of Angola’s 18 provinces, and at the nine PEPFAR-focused health facilities.

USAID-labeled boxes stacked in a store room.

As a result of the quantification exercise, warehouses such as this one that store PEPFAR-related commodities in Angola can optimize their inventory management because they are managing fewer types of medicines. Photo credit: Marieta do Rosário, GHSC-PSM

Quantification Will Lead to Cost Savings, Improved Efficiencies

“These reductions will result in significant cost savings, more efficient inventory stock management, and simplified distribution plans — yet, they will not impact patients adversely because we are not quantifying less need; we are optimizing the acquisition and management of regimens and associated medications in country,” notes Rebecca Turner, GHSC-PSM’s country director in Angola.

The director of the Clinical Support Department at INLS, Graça Elizabeth Daniel Manuel, offered a similar perspective: “We thank GHSC-PSM for its support and cooperation, especially in quantification, which resulted in simplification of ARV drugs for acquisitions.”

Moving forward, GHSC-PSM, INLS, and implementing partners are meeting quarterly to maintain and review a database that captures metrics including the total number of products procured and when products arrive in country. This inclusive process is having a significant positive impact on decision making at the national level.

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