Gils Tinne, Bossard Claire, Verdonck Kristien, Owiti Philip, Casteels Ilse, Mashako Maria, Van Cutsem Gilles, Ellman Tom
Médecins sans Frontières, Southern Africa Medical Unit, Cape Town, South Africa.
Institute of Tropical Medicine, Antwerp, Belgium.
PLoS One. 2018 Jan 19;13(1):e0191294. doi: 10.1371/journal.pone.0191294. eCollection 2018.
Stockouts of HIV commodities increase the risk of treatment interruption, antiretroviral resistance, treatment failure, morbidity and mortality. The study objective was to assess the magnitude and duration of stockouts of HIV medicines and diagnostic tests in public facilities in Kinshasa, Democratic Republic of the Congo. This was a cross-sectional survey involving visits to facilities and warehouses in April and May 2015. All zonal warehouses, all public facilities with more than 200 patients on antiretroviral treatment (ART) (high-burden facilities) and a purposive sample of facilities with 200 or fewer patients (low-burden facilities) in Kinshasa were selected. We focused on three adult ART formulations, cotrimoxazole tablets, and HIV diagnostic tests. Availability of items was determined by physical check, while stockout duration until the day of the survey visit was verified with stock cards. In case of ART stockouts, we asked the pharmacist in charge what the facility coping strategy was for patients needing those medicines. The study included 28 high-burden facilities and 64 low-burden facilities, together serving around 22000 ART patients. During the study period, a national shortage of the newly introduced first-line regimen Tenofovir-Lamivudine-Efavirenz resulted in stockouts of this regimen in 56% of high-burden and 43% of low-burden facilities, lasting a median of 36 (interquartile range 29-90) and 44 days (interquartile range 24-90) until the day of the survey visit, respectively. Each of the other investigated commodities were found out of stock in at least two low-burden and two high-burden facilities. In 30/41 (73%) of stockout cases, the commodity was absent at the facility but present at the upstream warehouse. In 30/57 (54%) of ART stockout cases, patients did not receive any medicines. In some cases, patients were switched to different ART formulations or regimens. Stockouts of HIV commodities were common in the visited facilities. Introduction of new ART regimens needs additional planning.
艾滋病毒药品缺货会增加治疗中断、抗逆转录病毒耐药性、治疗失败、发病和死亡的风险。本研究的目的是评估刚果民主共和国金沙萨公共设施中艾滋病毒药品和诊断检测的缺货程度及持续时间。这是一项横断面调查,于2015年4月和5月对各设施及仓库进行走访。选取了金沙萨所有的区域仓库、所有接受抗逆转录病毒治疗(ART)的患者超过200人的公共设施(高负担设施)以及一个有目的抽样的患者人数为200人或更少的设施(低负担设施)。我们重点关注三种成人ART制剂、复方新诺明片和艾滋病毒诊断检测。通过实地检查确定物品的可获得性,同时用库存卡核实直至调查走访当天的缺货持续时间。对于ART缺货情况,我们询问负责的药剂师该设施针对需要这些药品的患者采取了什么应对策略。该研究包括28个高负担设施和64个低负担设施,共为约22000名接受ART治疗的患者提供服务。在研究期间,新引入的一线治疗方案替诺福韦-拉米夫定-依非韦伦出现全国性短缺,导致56%的高负担设施和43%的低负担设施出现该方案缺货,直至调查走访当天,缺货持续时间的中位数分别为36天(四分位间距29 - 90天)和44天(四分位间距24 - 90天)。在至少两个低负担设施和两个高负担设施中发现其他每种被调查的商品都有缺货情况。在41例缺货案例中有30例(73%),该商品在设施中缺货但在上游仓库中有货。在57例ART缺货案例中有30例(54%),患者未收到任何药品。在某些情况下,患者被换用不同的ART制剂或治疗方案。在所走访的设施中,艾滋病毒商品缺货情况很常见。引入新的ART治疗方案需要额外的规划。