Factors associated with stock-outs of antiretroviral medicines in West Nile region, Uganda

Abstract

Background: In Uganda, despite the reduced costs of medications and increased support from the Ministry of Health and partners such as the Global Fund and the President’s Emergency Plan for AIDS Relief (PEPFAR), stock-outs of antiretroviral medicines remain a persistent challenge. There is a need to understand and document factors associated with stock-outs and how health facilities cope with treating patients with HIV/AIDS in the West Nile region. Objective: To understand the factors associated with stockouts of antiretroviral medicines and how health facilities cope with the treatment of HIV/AIDS patients in West Nile, Uganda. Methods: A mixed study was employed concurrently in this study. Both quantitative and qualitative data were collected at the same time. Quantitative data was collected using the stock cards while qualitative data was collected using a pre-tested, semi-structured interview guide. Results: The stock-out rate in West Nile facilities was 20.9% with paediatric formulation being the most stocked out, Nevirapine (NVP) 10mg/ml oral suspension having the highest stock our rate (56%). ARV commodities stocked out for at least greater than 15 days and HC IVs stock out lasted the longest days (42). Adults’ antiretroviral medicines formulations stocked out more often (54.7%) followed by paediatric formulations (30.2%). The stock-out rate of 20.9% in West Nile region was associated with national, district and facility-level factors, such as delays in deliveries from National Medical Stores and poor quantification, which were factors mentioned by all the participants. Mechanisms to cope with the observed stock-out prevalence were redistribution among facilities, submitting emergency orders, and ensuring proper quantification starting with proper documentation. Conclusion: The stock-out rate was greater than the nationally set target. Factors associated with the high stock-out rate were, at the national level; mostly delayed delivery of orders by National Medical Stores as per the delivery schedule coupled with a low order fulfillment rate of less than 100%. At the District Level, there was limited routine support supervision from the district health team, and at the facility level, improper quantification was the most associated contribution to the observed 20.9% stock-out rate.