Stockouts of HIV commodities in public health facilities in Kinshasa: Barriers to end HIV
Stockouts of HIV commodities in public health facilities in Kinshasa: Barriers to end HIV
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DOI：
10.1371/journal.pone.0191294
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发表时间：
2018-01-19
期刊：
影响因子：
3.7
通讯作者：
Ellman, Tom
中科院分区：
文献类型：
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作者：
Gils, Tinne;Bossard, Claire;Ellman, Tom
艾滋病毒商品缺货增加了治疗中断、抗逆转录病毒药物耐药性、治疗失败、发病率和死亡率的风险。研究的目的是评估刚果金沙萨公共设施艾滋病毒药物和诊断检测缺货的程度和持续时间。这是一项横断面调查，涉及2015年4月和5月对设施和仓库的访问。选择了金沙萨所有地区仓库、所有接受抗逆转录病毒治疗的病人超过200人的公共设施（高负担设施）和有目的抽样的病人不超过200人的设施（低负担设施）。我们重点研究了三种成人抗逆转录病毒疗法制剂、复方新诺明片剂和艾滋病毒诊断测试。通过实物检查确定物品的供应情况，而到调查访问之日为止的缺货时间则通过库存卡核实。在ART缺货的情况下，我们询问了负责的药剂师，对于需要这些药物的患者，设施的应对策略是什么。该研究包括28个高负担设施和64个低负担设施，共服务约22000名ART患者。在研究期间，新引入的一线方案替诺福韦-拉米夫定-依法韦仑的全国短缺导致56%的高负荷和43%的低负荷设施中该方案的缺货，分别持续了36天（四分位数范围29 +/- 90）和44天（四分位数范围24 +/- 90），直到调查访视当天。在至少两个低负荷和两个高负荷设施中，发现其他每种被调查商品都缺货。在30/41（73%）的缺货案例中，商品不在工厂，但在上游仓库。在30/57例（54%）抗逆转录病毒药物缺货病例中，患者未获得任何药物。在某些情况下，患者改用不同的ART制剂或方案。在所访问的设施中，艾滋病毒商品缺货的情况很普遍。引进新的抗逆转录病毒疗法需要额外的规划。
Stockouts of HIV commodities increase the risk of treatment interruption, antiretroviral resistance, treatment failure, morbidity and mortality. The study objective was to assess the magnitude and duration of stockouts of HIV medicines and diagnostic tests in public facilities in Kinshasa, Democratic Republic of the Congo. This was a cross-sectional survey involving visits to facilities and warehouses in April and May 2015. All zonal warehouses, all public facilities with more than 200 patients on antiretroviral treatment (ART) (high-burden facilities) and a purposive sample of facilities with 200 or fewer patients (low-burden facilities) in Kinshasa were selected. We focused on three adult ART formulations, cotrimoxazole tablets, and HIV diagnostic tests. Availability of items was determined by physical check, while stockout duration until the day of the survey visit was verified with stock cards. In case of ART stockouts, we asked the pharmacist in charge what the facility coping strategy was for patients needing those medicines. The study included 28 high-burden facilities and 64 lowburden facilities, together serving around 22000 ART patients. During the study period, a national shortage of the newly introduced first-line regimen Tenofovir-Lamivudine-Efavirenz resulted in stockouts of this regimen in 56% of high-burden and 43% of low-burden facilities, lasting a median of 36 (interquartile range 29 +/- 90) and 44 days (interquartile range 24 +/- 90) until the day of the survey visit, respectively. Each of the other investigated commodities were found out of stock in at least two low-burden and two high-burden facilities. In 30/41 (73%) of stockout cases, the commodity was absent at the facility but present at the upstream warehouse. In 30/57 (54%) of ART stockout cases, patients did not receive any medicines. In some cases, patients were switched to different ART formulations or regimens. Stockouts of HIV commodities were common in the visited facilities. Introduction of new ART regimens needs additional planning.