Boosting El Salvador's Supply Chain Logistics during COVID-19 to Ensure TLD Transition

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In El Salvador, the USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) program participated in revising the national treatment guidelines alongside the Ministry of Health (MOH) in 2019 for people living with HIV to include recent WHO recommendations, specifically around forecasting and supply planning. A critical update to the guidelines, which were finalized and published in 2020, is the introduction of tenofovir/lamivudine/dolutegravir (TLD). TLD, the optimal, first-line antiretroviral (ARV) for people living with HIV/AIDS, simplifies treatment, delivers faster viral load suppression and improves patients' genetic barriers.

“PEPFAR/USAID support through the GHSC-PSM project is essential at this critical time for TLD transition and to avoid inventory stockout for our HIV patients,” explained Dra. Ana Isabel Nieto, Chief of STI/HIV Program Unit.

However, the global pandemic in 2020 obstructed most commercial and productive sectors, limiting the procurement of critical HIV/AIDS commodities and challenging the transition to TLD for people living with HIV.

Planning and managing risks

In April 2020, GHSC-PSM worked with the STI/HIV Program Unit of MOH to brainstorm possible purchasing and inventory scenarios that could still occur despite COVID-19. Following a comprehensive risk review, which accounted for inventory and health workers and patients' acceptance of the new treatment conditions, GHSC-PSM and the STI/HIV Program Unit were able to establish three critical actions:

  • Guide health facilities to start migrating to TLD once the inventory of available ARVs is exhausted.
  • Adjust purchase requests to the Pan American Health Organization strategic fund according to the new July 2020 delivery plan to avoid overstock or expired inventory.
  • Advance the receipt dates for TLD by combining them into one shipment that arrived in September 2020, enough to treat 9,000 people living with HIV.

With the MOH facing difficult working conditions due to COVID-19, such as reduced warehouse staff and constraints on pharmacies, budgets and transportation, each of these three actions required close monitoring and risk management, which GHSC-PSM supported through remote follow-up. The project monitored inventory coverage for each health facility and the TLD transition progress, oversaw adjustments of the purchasing plan with the STI/HIV Program Unit of MOH and coordinated the logistics around on-time delivery of TLD.

Logistics and arrival of TLD

GHSC-PSM applied four key logistics components to ensure delivery of TLD:

  1. Quick analysis and selection of the best supply option to El Salvador using the available TLD inventory within GHSC-PSM's regional distribution centers, rather than placing an order with the manufacturer.
  2. Finding and managing the most optimal and immediate type of shipment (air) available, despite global transport constraints caused by the pandemic.
  3. Coordination of the documentation and authorizations needed to import and process customs clearance without delays.
  4. Utilization of forecasting and modeling to analyze the TLD transition for each health facility and provide feedback to the STI/HIV Program Unit on progress and possible barriers.

As a result of these efforts at least 85 percent of patients in the national cohort will be candidates for TLD by the end of 2021.

GHSC-PSM delivered 34,992 90-tablet bottles of TLD donated by PEPFAR and USAID, resulting in TLD treatment provided to 8,183 patients out of a total cohort of 10,523 patients.

As of February 2021, this goal to transition all people living with HIV to TLD is within reach; approximately 78 percent of people living with HIV now on TLD. The joint work of GHSC-PSM with MOH and USAID clinical implementing partners continues in 2021, with a plan to coordinate additional TLD shipments using the newly realized and efficient logistics system.