| dc.description.abstract | Background: HIV/AIDS treatment guidelines have been frequently revised in response to emerging evidence, experience, and practice in various countries (Richardson, Grant, & Zolopa, 2014). These revisions are intended to provide better options for HIV treatment. Introducing new antiretroviral therapy (ART) regimens poses numerous risks to the supply chain of ARVs whose consequences, such as stock-outs are life-threatening (USAID, 2009). This study aimed to assess the effects of transitions of 2018 and 2020 HIV treatment guidelines on availability of HIV commodities in health facilities in Kampala district. The specific objectives included; To assess availability of HIV commodities during HIV treatment guidelines transitions of 2018 and 2020. Identify the key challenges faced during HIV guidelines transitions of 2018 and 2020 in HIV clinics in Kampala district, determine how health facilities coped with challenges encountered during HIV guideline transition of 2018 and 2020 in HIV clinics in Kampala district.
Methods: An analytical cross-sectional design was employed for this study. A universal sample of 50 ART-accredited health facilities in Kampala district was considered. From each facility, one health worker who deals in HIV commodities management was selected purposively for the key informant interview. Data was collected using a semi-structured questionnaire and a key informant interview guide.
Quantitative data was entered into Epi Data version 4.6.02 and analyzed using STATA MP version 14. To assess the change in availability of HIV commodities, variables such as percentage of health facilities with HIV commodities available, months of stock and days out of stock before and after the transition of HIV treatment guidelines, Wilcoxon signed rank test was used for months of stock and days out of stock and Mcnemar test was used for the availability of ART. Thematic analysis was employed for qualitative data using Atlas ti Version 20 software. Descriptive statistics were summarized using frequencies, percentages, means and standard deviations for the quantitative data.
Results: All facilities (100%) had adult old regimens available before guideline revision. After revision, percentage of health facilities with adult old regimens reduced from 100% to 93.3% across all health facilities. Availability of adult new regimens was the only statistically significant variable (p<0.001) before and after the transitions. During interviews with store managers and dispensers shortage of some ART regimens was reported. The major coping strategy employed was borrowing from nearby facilities.
Adult old regimens had highest months of stock of 24.1, followed by adult new and pediatric regimen with 16.9 and 10.1 MOS respectively after the guideline’s revision. Months of stock for adult new regimens (p<0.001) before and after the transitions. Qualitative data particularly through interviews showed that some health facilities had a challenge of redundant stock of some regimens and lack of storage space. This was handled by contacting ware houses like JMS and MAUL to pick the stock or do re distributions to site that needed them. The highest number of days out of stock were 41.6 for adult new regimens, while the pediatric had 10.3 days and 9 days, respectively. Days out of stock for adult new (p<0.001) and pediatric regimens (p<0.001) were the statistically significant results before and after the transitions. During the interview with some stock managers, stock outs of HIV commodities was reported especially after guidelines transitions. The major coping strategy employed was borrowing from other facilities, issuing drugs for shorter periods say two weeks and contacting the IP to look around for some drugs.
Conclusion: The change in HIV treatment guidelines impacted on availability of stock of HIV commodities. There was high availability of old regimens before guidelines revision after revision adult old regimens become less available and adult new regimens become more available after guidelines revision. The study contributes to practice by informing the stakeholders such MOH, NMS, donors and implementing partners about the interruptions in the supply chain of HIV commodities such as reduced availability of some regimens,stockouts occur when HIV treatment guidelines transitions take place. | en_US |
