Lesotho and Namibia Surpass Targets for HIV Control.

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Lesotho and Namibia Surpass Targets for HIV Control.
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Related Supply Chain Topics
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Date
May 25, 2022
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Lesotho and Namibia were announced recently as two of six African countries that have achieved HIV epidemic control. According to the findings, these two countries had high levels of viral suppression and retention in care, indicating effective treatment programs that reduce infection rates and save lives. Data from the Population-based HIV Impact Assessment surveys shows that Lesotho and Namibia have made remarkable progress toward HIV epidemic control.

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A picture of HIV Commodities
A picture of HIV Commodities
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HIV commodities
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Lesotho
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The GHSC-PSM project in Lesotho supported the government of Lesotho and PEPFAR priorities for global commodity procurement and logistics between 2016 and 2021. The project has provided technical assistance to improve the long-term availability of health commodities and strengthen national supply chain institutions, including the Supply Chain Management Department (SCMD), the National Drug Services Organization (NDSO), and the District Health Management Teams (DHMTs). 

Furthermore, the project ensured the continued availability of HIV commodities, tuberculosis (TB) preventive treatment (TPT), pre-exposure prophylaxis (PrEP), and Family Planning commodities at the central and facility levels. The availability of commodities supported partners to attain PEPFAR testing, treatment targets, and objectives, including ARV optimization, 3HP transition, and differentiated service delivery models like multi-month dispensing (MMD). All of these approaches have been essential to guiding the country toward HIV epidemic control. As of March 2020 in Lesotho, 90 percent of HIV-positive adults were aware of their status, 97 percent were receiving antiretroviral treatment, and 92 percent were virally suppressed. 

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Namibia
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There is high access to HIV care in Namibia, with more than 190 000 clients actively on ART treatment indicating significant progress towards reaching or exceeding the UNAIDS 90–90–90 targets. The project in Namibia implements various supply chain and technical assistance activities to ensure uninterrupted supplies of ART medicines in the country. Technical assistance is provided to the Central Medical Store in forecasting and quantifying needs for ARVs in the country. This forecasting ensures that adequate supplies of medicines are available. The project uses various tools and methods to ensure the accuracy of forecasts. In 2019, GHSC-PSM assisted Namibia in developing a needs-based budget methodology that used various parameters to ensure that the national budget was distributed equitably to all the country’s 14 regions. Every year since then, CMS and the Ministry of Health and Social Services (MoHSS) have depended on the project to assist in allocating budgets to the health facilities. 

In 2019, GHSC-PSM assisted the MoHSS in changing ART treatment guidelines. The project was instrumental in bringing in the new treatment Tenofovir, Lamivudine, and Dolutegravir (tld) pills in 90-count and 180-count bottles to make it easier for pharmacy staff to implement MMD in three- and six-month multiples. Some of the products were directly procured, and forecasting technical assistance was provided to the MoHSS for government procurement.

When the COVID-19 pandemic began in 2020, GHSC-PSM played a critical role in predicting supply chain shocks. The project provided technical assistance in quantifying and pushing the stock to decongest facilities. The project advocated for multi-month dispensing through the ART Supply Chain Technical Working Group (MMD). For this implementation, facilities needed to have enough stock to start the process. This intervention was successfully implemented, and the project assisted the MoHSS by monitoring progress. At the outset in 2019, 3% of patients received 6 months of ARVs; by December 2021, this had increased to 25%. MMD has been associated with increased adherence to treatments, viral load suppression, and improved patient outcomes.
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Namibia's trends in multi-month dispensing (MMD) between Dec 2019 - Dec 2021
Namibia's trends in multi-month dispensing (MMD) between Dec 2019 - Dec 2021
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Namibia's trends in multi-month dispensing (MMD) between Dec 2019 - Dec 2021
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Controlling the epidemic necessitates collaborating and accelerating efforts to identify and connect those most vulnerable to HIV infection with treatment and prevention services. The project will continue building upon the work that has begun in order to serve those in need of treatment, and achieve HIV epidemic control.