Department of Pharmacy, Radboudumc Research Institute for Medical Innovation (RIMI), Radboud University Medical Center, Nijmegen, The Netherlands.
Access to Medicines Platform Kenya, Nairobi, Kenya.
HIV Med. 2024 Jul;25(7):805-816. doi: 10.1111/hiv.13635. Epub 2024 Mar 18.
The large number of deaths among children with HIV is driven by poor antiretroviral treatment (ART) coverage among this cohort. The aim of the study was to assess the availability and stock-outs of paediatric and adult ART formulations in Kenya and Uganda across various regions and types of health facilities.
A survey on availability and stock-outs of paediatric ART at health facilities was adapted from the standardized Health Action International-WHO Medicine Availability Monitoring Tool. All preferred and limited-use formulations, and three phased-out formulations according to the 2021 WHO optimal formulary list were included in the survey, as well as a selection of adult ART formulations suitable for older children, adolescents, and adults. Availability data were collected in June-July 2022 and stock-out data were obtained over the previous year from randomly selected public and private-not-for-profit (PNFP) facilities registered to dispense paediatric ART across six districts per country. All data were analysed descriptively.
In total, 144 health facilities were included (72 per country); 110 were public and 34 PNFP facilities. Overall availabilities of preferred paediatric ART formulations were 52.2% and 63.5% in Kenya and Uganda, respectively, with dolutegravir (DTG) 10 mg dispersible tablets being available in 70.2% and 77.4% of facilities, respectively, and abacavir/lamivudine dispersible tablets in 89.8% and 98.2% of facilities. Of note, availability of both formulations was low (37.5% and 62.5%, respectively) in Kenyan PNFP facilities. Overall availabilities of paediatric limited-use products were 1.1% in Kenya and 1.9% in Uganda. At least one stock-out of a preferred paediatric ART formulation was reported in 40.0% of Kenyan and 74.7% of Ugandan facilities. Nevirapine solution stock-outs were reported in 43.1% of Ugandan facilities, while alternative formulations for postnatal HIV prophylaxis were not available.
Recommended DTG-based first-line ART for children across all ages was reasonably available at health facilities in Kenya and Uganda, with the exception of Kenyan PNFP facilities. Availability of paediatric ART formulations on the limited-use list was extremely low across both countries. Stock-outs were reported regularly, with the high number of reported stock-outs of neonatal ART formulations in Uganda being most concerning.
大量艾滋病毒感染儿童死亡的原因是该人群接受抗逆转录病毒治疗（ART）的比例较低。本研究的目的是评估肯尼亚和乌干达各地区和各类卫生机构中儿童和成人 ART 制剂的供应情况和缺货情况。
根据卫生行动国际-世界卫生组织药品供应监测工具的标准，对卫生设施提供的儿童 ART 制剂进行了一项可用性和缺货情况调查。该调查包括所有首选和有限使用制剂，以及根据 2021 年世界卫生组织最佳配方清单淘汰的三种制剂，以及适合较大儿童、青少年和成人的成人 ART 制剂。2022 年 6 月至 7 月收集了供应数据，前一年的缺货数据则从两国六个地区登记的提供儿童 ART 的公立和非营利性（PNFP）医疗机构中随机选择的机构获得。所有数据均进行了描述性分析。
共有 144 家卫生机构（每家国家各 72 家）被纳入，其中 110 家为公立机构，34 家为非营利性机构。肯尼亚和乌干达首选儿童 ART 制剂的总体供应率分别为 52.2%和 63.5%，多替拉韦 10mg 分散片分别在 70.2%和 77.4%的机构中供应，阿巴卡韦/拉米夫定分散片分别在 89.8%和 98.2%的机构中供应。值得注意的是，肯尼亚的 PNFP 机构中这两种制剂的供应率均较低（分别为 37.5%和 62.5%）。肯尼亚儿童有限使用产品的总体供应率为 1.1%，乌干达为 1.9%。在肯尼亚 40.0%的机构和乌干达 74.7%的机构报告了至少一种首选儿童 ART 制剂缺货。43.1%的乌干达机构报告了奈韦拉平溶液缺货，而新生儿艾滋病毒预防替代制剂则无法供应。
在肯尼亚和乌干达，除了肯尼亚的非营利性机构外，所有年龄段儿童使用的以多替拉韦为基础的一线抗逆转录病毒治疗方案在卫生机构中都有合理的供应。两国的有限使用名单上的儿科 ART 制剂供应非常有限。定期报告缺货情况，乌干达新生儿 ART 制剂大量缺货情况最令人担忧。
