Availability and stock-outs of paediatric antiretroviral treatment formulations at health facilities in Kenya and Uganda

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine Pub Date : 2024-03-18 DOI:10.1111/hiv.13635

Tom G. Jacobs, Dorothy Okemo, Anthony Ssebagereka, Kenneth Mwehonge, Emily M. Njuguna, David M. Burger, Angela Colbers, Fatima Suleman, Aukje K. Mantel-Teeuwisse, Gaby I. Ooms

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引用次数: 0

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusions

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.

Abstract Image

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肯尼亚和乌干达医疗机构儿科抗逆转录病毒治疗配方的可用性和缺货情况。

导言：由于抗逆转录病毒疗法（ART）在感染艾滋病毒儿童中的覆盖率较低，导致大量儿童死亡。本研究旨在评估肯尼亚和乌干达不同地区和不同类型医疗机构的儿科和成人抗逆转录病毒疗法制剂的供应和缺货情况：方法：根据标准化的国际健康行动组织-世界卫生组织药品供应监测工具，对医疗机构儿科抗逆转录病毒疗法的供应和缺货情况进行了调查。根据 2021 年世卫组织最佳处方集清单，所有首选和限用制剂以及三种逐步淘汰的制剂都被纳入了调查范围，同时还选择了一些适合年龄较大儿童、青少年和成人的成人抗逆转录病毒疗法制剂。2022年6月至7月收集了可用性数据，前一年的缺货数据则是从每个国家6个地区中随机抽取的注册配发儿科抗逆转录病毒疗法的公立和私营非营利（PNFP）机构中获得的。对所有数据进行了描述性分析：结果：共纳入 144 家医疗机构（每个国家 72 家），其中 110 家为公立医疗机构，34 家为私营非营利医疗机构。在肯尼亚和乌干达，首选儿科抗逆转录病毒疗法制剂的总体供应率分别为 52.2% 和 63.5%，分别有 70.2% 和 77.4% 的医疗机构提供 10 毫克多托曲韦分散片，89.8% 和 98.2% 的医疗机构提供阿巴卡韦/拉米夫定分散片。值得注意的是，在肯尼亚的 PNFP 机构中，这两种制剂的供应率较低（分别为 37.5% 和 62.5%）。在肯尼亚和乌干达，儿科限用产品的总体供应率分别为 1.1%和 1.9%。据报告，40.0% 的肯尼亚医疗机构和 74.7% 的乌干达医疗机构至少出现过一次首选儿科抗逆转录病毒疗法制剂缺货的情况。据报告，43.1% 的乌干达医疗机构出现了奈韦拉平溶液缺货的情况，而用于产后艾滋病预防的替代制剂则无法获得：除肯尼亚的 PNFP 机构外，肯尼亚和乌干达的医疗机构均可合理地为所有年龄段的儿童提供推荐的基于 DTG 的一线抗逆转录病毒疗法。在这两个国家，有限使用清单上的儿科抗逆转录病毒疗法制剂供应量极低。经常有缺货的报告，其中乌干达新生儿抗逆转录病毒疗法制剂缺货的报告数量之多最令人担忧。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

HIV Medicine 医学-传染病学

CiteScore

5.10

自引率

10.00%

发文量

167

审稿时长

6-12 weeks

期刊介绍： HIV Medicine aims to provide an alternative outlet for publication of international research papers in the field of HIV Medicine, embracing clinical, pharmocological, epidemiological, ethical, preclinical and in vitro studies. In addition, the journal will commission reviews and other feature articles. It will focus on evidence-based medicine as the mainstay of successful management of HIV and AIDS. The journal is specifically aimed at researchers and clinicians with responsibility for treating HIV seropositive patients.