One Patient’s Experience Shows the Value of Multi-Month Dispensing

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Sixty-year-old Jolly Mubanga and his wife have four children and two grandchildren, and live in Ndola, Zambia’s third-largest city. Both are on treatment for HIV/AIDS and receive their medicines through multi-month dispensing (MMD), a strategy that moves patients from monthly to three- or six-month prescriptions.

MMD, promoted by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), is a patient-centered strategy that aims to reduce the burden of having to visit pharmacies monthly to pick up medicines. For Jolly, who is a driver by trade, every hour saved going to the pharmacy is an hour he can be earning more to support his family.

Jolly and his wife differ in their dispensing protocols. She receives her medicines every three months, while he receives his every six months, in part because Jolly transitioned to the fixed-dose combination of Tenofovir/Lamivudine/Dolutegravir (TLD) in July 2019. Nevertheless, their MMD schedule eliminates two pharmacy visits every three months, saving Jolly ZMW 1,600 ($84) and 20 hours of travel annually. Although he does not worry so much about the travel to the pharmacy, he has noticed that MMD has reduced congestion and long lines during his visits, cutting down on his wait time from two hours on average to about 45 minutes.

“This is a very welcome move. It has cut down on costs and frequent movement to the hospital, which has resulted in decongestion at health facilities. It has not only cut down on costs but is encouraging adherence and consistency in taking drugs as they are readily available,” explained Jolly.

The USAID Global Health Supply Chain-Procurement and Supply Management (GHSC-PSM) project in Zambia ensures availability of sufficient TLD at Central Medical Stores (MSL) so that medicines are available at service delivery points to fulfill MMD and support patients like Jolly and his wife. Close demand monitoring through supply plan analysis and expediting shipments of TLD are some of the strategies the project uses to ensure TLD is available to patients. GHSC-PSM also strengthens facility-level reporting on average monthly consumption (AMC) data; stock on hand; and assesses how much MSL needs to resupply the facilities. The project also analyzes the AMC and central-level stock-on-hand to forecast what the facilities’ stock needs are for the next 12 months.

Additonally, through the GHSC-PSM-supported monthly supply chain partner meetings, the project coordinates with USAID and its implementing partners to discuss the progress made in meeting PEPFAR’s MMD targets, and identify solutions to address challenges faced by implementing partners. 

GHSC-PSM collaborates with MSL to review and use volumetric data for TLD to translate provincial and district-level allocated quantities to truck sizes and distribution routes. A distribution schedule is then generated, six months’ supply of ARVs are front loaded and third-party logistics (3PL) companies to distribute to the facility level are identifyed.

Through GHSC-PSM’s support, the project contributes to saving the lives of over 920,000 people living with HIV/AIDS, including Jolly and his wife - enabling them to live healthy and productive lives.

During the last hospital visit, Jolly received six bottles of 30 pills each. At his next visit, he will be able to access the TLD 90 count bottles because GHSC-PSM procured and delivered over one million TLD bottles between October 2019 to date. Jolly looks forward to getting the 90-count bottles because they are easier to carry and store when he is working out of town.