In South Africa there are 7.5 million people living with HIV. Approximately 5 million of these people use antiretroviral therapy (ART). Until recently, a large percentage of ART patients were on a Tenofovir/Efavirenz/Emtricitabine (TEE) based regimen and needed to regularly travel to healthcare facilities to access their chronic medication.
The National Department of Health (NDoH) in South Africa began transitioning ART recipients to a Tenofovir/Lamivudine/Dolutegravir (TLD) based regimen for effective, sustainable HIV solutions. The NDoH began transitioning ART recipients to TLD–based regimens and exploring alternative delivery channel solutions to decongest healthcare facilities.
In 2018, the Affordable Medicines Directorate (AMD) of the NDoH asked the ARC, Africa’s Public Health Supply Chain Institution to drive the supply chain planning for the transition to TLD, while maintaining full availability of the old regimen.
ARC assisted the AMD with developing a methodology for introducing new products; helped plan in phase-in and phase-out periods of TLD and TEE across all provinces; and identified, appointed and secured funding for a team to run the TLD transition plan as a structured pilot, within a broader visibility and analytics network operating model and implementation project.
The transition was launched in KwaZulu-Natal in the final quarter of 2019. Due to the COVID-19 pandemic, the transition could not be completed in 2020 and the timelines were extended into 2021.
Need for increased investment in alternative drug distribution models for chronic meds, like ART, brought to fore by TLD transition work. ARC worked with the NDoH, donors and district support partners to analyse the existing supply landscape, and to develop a business case for direct delivery of chronic medicines, including ART.
A multi-month dispensing (MMD) model was identified as an important step for increasing the availability of medicines for chronic patients. MMD provides stable patients with uninterrupted access to medications. MMD usual happens in three- or six-month batches.
Both periods were considered, and the NDoH opted to focus on the three-month MMD approach in the initial phase.
ARC has supported the NDoH with supply chain planning to roll out MMD to all stable patients.
ARC’s support to ministries of health focuses on strengthening six supply chain elements. The work with the NDoH and AMD on the TLD transition and MMD strengthened four of these six areas: strategy, improvement roadmap, policies and research and solutions proposals.
Facilitating an effective regime transition
Key elements: strategy and improvement roadmap
The TLD transition included extensive strategic work and was developed from the beginning to be applicable to future medicine transitions.
IMPACT: By July 2022 the TLD:TEE ratio was above 87:13 %.
Understanding the supply landscape
Key elements: policies and research
ARC supported NDoH‘s models with extensive analysis/research of supply landscape. This informed the MMD approach to meet patient needs.
IMPACT: MMD will provide stable patients with uninterrupted access to medications.
Integrating adaptability into supply planning
Key element: solutions proposals
The ART regimen transition and investment into increasing the availability of medicines to chronic patients were designed in a way that allowed them to withstand and adapt to the effects of the disruption caused by the COVID-19 pandemic.
IMPACT: Chronic patients have increasingly resilient channels through which to access medicines for their conditions.