Adopting and Transitioning to the New Pediatric ARV in Zambia

Related Supply Chain Topics
Related Global Health Areas
Lead Paragraph/Summary

Great strides have been made in HIV treatments in the past several decades, especially with adult antiretrovirals (ARVs) and formulations. But a solemn report from UNAIDS in July 2021 showed that “almost half (46%) of the world’s 1.7 million children living with HIV (CLHIV) were not on treatment in 2020.”

Part of the issue has been access to affordable, easy-to-use and most importantly, highly effective medicine with low side effects. With a new treatment, the global health community has the opportunity to change that. The U.S. Food and Drug Administration (FDA) approved a long-awaited pediatric HIV treatment known as a dispersible 10mg formulation of dolutegravir (DTG) in late 2020. Thanks to Unitaid and the Clinton Health Access Initiative (CHAI), DTG 10mg is also available at a lower cost, making it affordable.

Martha Sakala and Soneni Chelemu, Pharmacists at University Teaching Hospital in Lusaka, Zambia showing bottles of DTG 10mg.
Martha Sakala and Soneni Chelemu, Pharmacists at University Teaching Hospital in Lusaka, Zambia showing bottles of DTG 10mg.
Martha Sakala and Soneni Chelemu, Pharmacists at University Teaching Hospital in Lusaka, Zambia showing bottles of DTG 10mg. Photo: GHSC-PSM.
Body Text

As one of the first adopters of DTG 10mg, children living with HIV (CLHIV) in Zambia will now be able to access the new, more effective ARV. The USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) project delivered more than 33,000 bottles of DTG 10mg to Zambia between June and July.

Zambia faced similar key challenges to pediatric viral suppression, including lack of age-appropriate formulations and storage for some medicines, below standard dosing and poor adherence. To address them, the Zambian government chose to optimize treatment for children as recommended by the World Health Organization (WHO):

  • User-friendly, quality-assured ARVs that meet WHO requirements with dosing flexibility are cost-competitive and benefit from an optimized supply chain.
  • An optimized pediatric antiretroviral therapy (ART) options list that promotes adherence and thereby promotes viral-load suppression.

About 9,000 ART clients below the age of nine and weighing from three to 20 kilograms will benefit from the availability of DTG 10mg.

With the support of GHSC-PSM, the rollout of DTG 10mg began in August in three phases that will help support continuous monitoring and will conclude in January 2022.

“The first phase has already started with the supply chain properly secured. All facilities in phase one have received their allocated commodities and have started transitioning children from LPV/r-based to DTG-based regimens, “said Dr. Gloria Munthali, the Ministry of Health (MOH) National Pediatric ART Coordinator.

Working Together

GHSC-PSM is one of several partners—including CHAI, U.S. Centers for Disease Control and Prevention (CDC), PEPFAR and USAID—supporting the MOH with DTG 10mg rollout. The CDC, CHAI and USAID supported the MOH in developing and printing training materials and conducted training in the use of DTG 10mg for facility-level health workers. In preparation for DTG 10mg rollout in Zambia, GHSC-PSM worked with clinical partners on updating standard treatment guidelines and facilitated its inclusion in the electronic logistics management information system (eLMIS).

“DTG 10mg is a new addition to the Zambia optimal drug list with better palatability, tolerability, potency and resistance profile which will improve viral load suppression in children. It is a welcome breakthrough as it will improve children’s adherence to antiretroviral treatment,” said Dr. Gloria Munthali.

Through its third-party logistics (3PL) support to the Zambia Medicines and Medical Supplies Agency, GHSC-PSM facilitated the first delivery of DTG 10mg to provincial hubs in Zambia’s 10 provinces. The project also assisted the MOH in determining the first health facilities to receive 20,000 bottles of DTG 10mg by analyzing facility-level data to identify 57 high-volume facilities for the initial distribution.

Moving forward, GHSC-PSM is working closely with the MOH to conduct annual forecasting and quarterly supply plan reviews while monitoring stock availability, both centrally and at facilities. The project will also be regularly supporting health facilities with real-time logistics data capturing and reporting. In turn, GHSC-PSM will communicate with USAID and clinical partners on transition rates.