South Africa has one of the highest rates of HIV prevalence in the world, with around 7.5 million people in the country living with HIV. Approximately five million of these people use antiretroviral therapy (ART). Until recently, most have been on a Tenofovir/Efavirenz /Emtricitabine (TEE) based regimen. To continue providing effective, sustainable chronic medication solutions for people living with HIV, the National Department of Health (NDoH) in South Africa began the process of transitioning recipients of ART to a Tenofovir/Lamivudine /Dolutegravir (TLD) based regimen.
The TLD transition was the largest switchover in the history of such ART programmes. The NDoH required significant manufacturer engagement to plan for supply availability while targeting optimum stock levels of products being phased in and out. Other factors that affected the regimen change included long lead times for drug registration, and the time taken to complete the updated clinical guidelines for the new regimen.
In 2018, the Affordable Medicines Directorate (AMD) of the NDoH engaged the Africa Resource Centre (ARC) to drive the supply chain planning for the TLD transition. ARC supported the NDoH to plan the introduction of TLD, while maintaining full availability of both the old and new regimens.
ARC assisted the AMD with developing a methodology for introducing new products, beginning with TLD, with the intent to replicate this approach on subsequent product launches.
ARC helped develop a plan that included optimal phase-in and phase-out periods across all provinces, with the full switchover intended to be completed within one year.
ARC 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 (VAN) operating model and implementation project. The VAN dashboard provided visibility of stock levels for both the incoming and outgoing regimens across the supply chain.
The transition was launched in KwaZulu-Natal in the final quarter of 2019. Most of the country’s nine provinces commenced the transition in early 2020. Due to the COVID-19 pandemic, the transition could not be completed in 2020 and is expected to conclude in 2021.
OUTCOMES AND IMPACT
ARC’s support to ministries of health focuses on strengthening six supply chain elements. The work with the NDoH and AMD strengthened four of these six areas: strategy, improvement roadmap, governance and solutions proposals.
SUPPORTING INCREASED VISIBILITY ACROSS THE SUPPLY CHAIN
Key element: strategy
The VAN dashboard shows stock levels by province, making it possible to determine which provinces are well covered and which are at risk of having too little stock.
IMPACT: ARC supported the NDoH with a best practice approach to manage and secure stock levels for a switchover of this scale.
CREATING A ROADMAP FOR FUTURE TRANSITIONS
Key element: improvement roadmap and solutions proposals
The ultimate purpose of this project was to develop a methodology that defined the supply chain processes for introducing new products into the healthcare system in South Africa.
IMPACT: ARC documented the TLD transition methodology to support the use of this approach in the future.
FACILITATING COLLABORATION ACROSS THE SUPPLY CHAIN
Key element: governance
ARC facilitated close cooperation between suppliers, pharmaceutical services and provincial HIV programmes to enable joint planning and course correction. ARC’s TLD transition team was seen as the “go-to” people and was called on to assist in areas outside of supply chain.
IMPACT: ARC ensured supply chain plans were updated and communicated accordingly so that all stakeholders remained informed and aligned.