1. Stock-outs of antiretroviral and tuberculosis medicines in South Africa: A national cross-sectional survey
- Author
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Andrew Boulle, Sarah Jane Steele, Lauren Jankelowitz, Gilles van Cutsem, Tinne Gils, Kristal Duncan, John Stephens, Anele Yawa, Bella Hwang, Anna Grimsrud, Marije Versteeg-Mojanaga, Sasha Stevenson, Indira Govender, Amir Shroufi, and Julia Hill
- Subjects
Male ,Bacterial Diseases ,RNA viruses ,Cross-sectional study ,Epidemiology ,Human immunodeficiency virus (HIV) ,Antitubercular Agents ,HIV Infections ,medicine.disease_cause ,Pathology and Laboratory Medicine ,Pediatrics ,Geographical locations ,South Africa ,0302 clinical medicine ,Immunodeficiency Viruses ,Surveys and Questionnaires ,Medicine and Health Sciences ,Public and Occupational Health ,030212 general & internal medicine ,Community Health Services ,Multidisciplinary ,Antimicrobials ,Public sector ,Drugs ,Antiretrovirals ,Antivirals ,Vaccination and Immunization ,Infectious Diseases ,Anti-Retroviral Agents ,Medical Microbiology ,HIV epidemiology ,Viral Pathogens ,Viruses ,Medicine ,Female ,Public Health ,Pathogens ,Research Article ,medicine.medical_specialty ,Tuberculosis ,Science ,030231 tropical medicine ,Immunology ,MEDLINE ,Antiretroviral Therapy ,Microbiology ,03 medical and health sciences ,Antiviral Therapy ,Environmental health ,Microbial Control ,Virology ,Retroviruses ,medicine ,Humans ,Microbial Pathogens ,Stock (geology) ,Pharmacology ,Public Sector ,business.industry ,Public health ,Lentivirus ,Organisms ,Biology and Life Sciences ,HIV ,medicine.disease ,Tropical Diseases ,Regimen ,Cross-Sectional Studies ,Africa ,Health Facilities ,Preventive Medicine ,People and places ,business ,Public Health Administration - Abstract
BackgroundHIV and TB programs have rapidly scaled-up over the past decade in Sub-Saharan Africa and uninterrupted supplies of those medicines are critical to their success. However, estimates of stock-outs are largely unknown. This survey aimed to estimate the extent of stock-outs of antiretroviral and TB medicines in public health facilities across South Africa, which has the world's largest antiretroviral treatment (ART) program and a rising multidrug-resistant TB epidemic.MethodsWe conducted a cross-sectional telephonic survey (October-December 2015) of public health facilities. Facilities were asked about the prevalence of stock-outs on the day of the survey and in the preceding three months, their duration and impact.ResultsNationwide, of 3547 eligible health facilities, 79% (2804) could be reached telephonically. 88% (2463) participated and 4% (93) were excluded as they did not provide ART or TB treatment. Of the 2370 included facilities, 20% (485) reported a stock-out of at least 1 ARV and/or TB-related medicine on the day of contact and 36% (864) during the three months prior to contact, ranging from 74% (163/220) of health facilities in Mpumalanga to 12% (32/261) in the Western Cape province. These 864 facilities reported 1475 individual stock-outs, with one to fourteen different medicines out of stock per facility. Information on impact was provided in 98% (1449/1475) of stock-outs: 25% (366) resulted in a high impact outcome, where patients left the facility without medicine or were provided with an incomplete regimen. Of the 757 stock-outs that were resolved 70% (527) lasted longer than one month.InterpretationThere was a high prevalence of stock-outs nationwide. Large interprovincial differences in stock-out occurrence, duration, and impact suggest differences in provincial ability to prevent, mitigate and cope within the same framework. End-user monitoring of the supply chain by patients and civil society has the potential to increase transparency and complement public sector monitoring systems.
- Published
- 2019