PLoS ONE (Jan 2019)

Stock-outs of antiretroviral and tuberculosis medicines in South Africa: A national cross-sectional survey.

  • Bella Hwang,
  • Amir Shroufi,
  • Tinne Gils,
  • Sarah Jane Steele,
  • Anna Grimsrud,
  • Andrew Boulle,
  • Anele Yawa,
  • Sasha Stevenson,
  • Lauren Jankelowitz,
  • Marije Versteeg-Mojanaga,
  • Indira Govender,
  • John Stephens,
  • Julia Hill,
  • Kristal Duncan,
  • Gilles van Cutsem

DOI
https://doi.org/10.1371/journal.pone.0212405
Journal volume & issue
Vol. 14, no. 3
p. e0212405

Abstract

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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.