Performance of antiretroviral drugs supply chain management and related challenges in Amhara National Regional State, Ethiopia. In the case of public health facilities found in the Central Gondar zone

Abstract

Background

Effective human immunodeficiency virus (HIV) treatment depends on uninterrupted delivery of prescribed antiretroviral (ARV) drug regimens at anti-retroviral therapy (ART) sites. However, interruptions in access and stock outs are the major challenges in the supply chain of antiretroviral drugs. The issues are very high, particularly in developing countries like Ethiopia. Therefore, this study aimed to assess the supply chain performance of ARV drugs and its challenges in public health facilities in the Central Gondar Zone.

Methods

A descriptive cross-sectional survey complemented by a qualitative research approach was conducted in 30 health facilities (7 hospitals and 23 health centers) that provide ART services. Structured self-administered questionnaires and observational checklists were used to collect quantitative data, while qualitative data were collected using semi-structured open-ended interview guides. Quantitative data was analyzed using SPSS version 26 and Microsoft Excel 2013. A thematic approach was used to examine the qualitative data, which required careful reading of the transcripts to find important themes.

Results

This study revealed that, at the surveyed health facilities, the availability and utilization of bin cards were found to be 100 %. Bin card updating in the surveyed facilities was 90.4 % and 87.2 % on average at hospitals and health centers, respectively. The study found that stock outs of ARV drugs were high in hospitals (16.14 %) as compared to health centers (9.2 %). Lamivudine (3TC) + Dolutegravir (DTG) + Tenofovir (TDF) (300 mg + 50 mg + 300 mg) of 30 tablets was the most frequently stocked-out drug at hospitals and health centers in about 57 % and 39 %, respectively. About 42.8 % of hospitals and 26 % of health centers placed at least two emergency orders within the previous six months at the time of data collection. The storage condition of ARV drugs was not good (68.99 %) in health centers. However, it was better in hospitals and met the criteria for good storage conditions (89.52 %).The qualitative findings also revealed that inadequate infrastructure, a shortage of trained and qualified staff, and a lack of vehicles were the major challenges.

Conclusion

Overall, the study indicated that the surveyed health facilities were not satisfied with the timely updating of bin cards. Additionally, it identified issues such as stock outs of ARV drugs, poor storage conditions (particularly in health centers), inadequate infrastructure, a shortage of trained and qualified staff, and a lack of vehicles. Therefore, to improve the performance of ARV drug supply chain management, all the concerned bodies should work cooperatively in maintaining quality data and be dedicated to updating inventory recording tools, creating standard storage conditions, as well as recruiting pharmacy professionals, facilitating capacity-building training, and offering ongoing mentorship and supervision. Suppliers should maintain adequate inventory at their hub and collaborate with healthcare facilities. The healthcare facilities' should utilize automated inventory-controlling systems.