Stock-outs of antiretroviral and tuberculosis medicines in South Africa: A national cross-sectional survey
Stock-outs of antiretroviral and tuberculosis medicines in South Africa: A national cross-sectional survey
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DOI：
10.1371/journal.pone.0212405
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发表时间：
2019-03-12
期刊：
影响因子：
3.7
通讯作者：
van Cutsem, Gilles
中科院分区：
文献类型：
--
作者：
Hwang, Bella;Shroufi, Amir;van Cutsem, Gilles
背景艾滋病毒和结核病项目在过去十年中在撒哈拉以南非洲地区迅速扩大，这些药物的不间断供应对其成功至关重要。然而，缺货的估计在很大程度上是未知的。这项调查旨在估计南非各地公共卫生设施中抗逆转录病毒药物和结核病药物的缺货程度，南非拥有世界上最大的抗逆转录病毒治疗 (ART) 计划，并且耐多药结核病疫情不断上升。方法我们对公共卫生设施进行了横断面电话调查（2015 年 10 月至 12 月）。机构被问及调查当天和前三个月缺货的发生率、持续时间和影响。结果在全国 3547 个符合条件的医疗机构中，79% (2804) 可以通过电话联系。 88% (2463) 参与，4% (93) 因不提供 ART 或结核病治疗而被排除。在 2370 家医疗机构中，20% (485) 报告称在接触当天至少有 1 种抗逆转录病毒药物和/或结核病相关药物缺货，36% (864) 则报告在接触前三个月内缺货，范围从普马兰加省的 74% (163/220) 医疗机构到西开普省的 12% (32/261)。这 864 家机构报告了 1475 种缺货情况，其中每家机构有 1 到 14 种不同的药品缺货。 98% (1449/1475) 的缺货中提供了有关影响的信息：25% (366) 的缺货导致了高影响结果，即患者在没有药物的情况下离开机构或提供的治疗方案不完整。在已解决的757起缺货事件中，70%（527起）持续时间超过1个月。解读全国缺货发生率较高。省际间在缺货发生情况、持续时间和影响方面存在较大差异，表明各省在同一框架内预防、缓解和应对的能力存在差异。患者和民间社会对供应链的最终用户监测有可能提高透明度并补充公共部门监测系统。
BackgroundHIV and TB programs have rapidly scaled-up over the past decade in Sub-Saharan Africa and uninterrupted supplies of those medicines are critical to their success. However, estimates of stock-outs are largely unknown. This survey aimed to estimate the extent of stock-outs of antiretroviral and TB medicines in public health facilities across South Africa, which has the world's largest antiretroviral treatment (ART) program and a rising multidrug-resistant TB epidemic.MethodsWe conducted a cross-sectional telephonic survey (October-December 2015) of public health facilities. Facilities were asked about the prevalence of stock-outs on the day of the survey and in the preceding three months, their duration and impact.ResultsNationwide, of 3547 eligible health facilities, 79% (2804) could be reached telephonically. 88% (2463) participated and 4% (93) were excluded as they did not provide ART or TB treatment. Of the 2370 included facilities, 20% (485) reported a stock-out of at least 1 ARV and/or TB-related medicine on the day of contact and 36% (864) during the three months prior to contact, ranging from 74% (163/220) of health facilities in Mpumalanga to 12% (32/261) in the Western Cape province. These 864 facilities reported 1475 individual stock-outs, with one to fourteen different medicines out of stock per facility. Information on impact was provided in 98% (1449/1475) of stock-outs: 25% (366) resulted in a high impact outcome, where patients left the facility without medicine or were provided with an incomplete regimen. Of the 757 stock-outs that were resolved 70% (527) lasted longer than one month.InterpretationThere was a high prevalence of stock-outs nationwide. Large interprovincial differences in stock-out occurrence, duration, and impact suggest differences in provincial ability to prevent, mitigate and cope within the same framework. End-user monitoring of the supply chain by patients and civil society has the potential to increase transparency and complement public sector monitoring systems.