ARC performed an independent advisory role to shape the overall TLD transition project and brokered additional expert resources from Novo Nordisk and a local private sector consultant to support the initiative.
Date:
September 22, 2021
Author(s):
Africa Resource Centre
BACKGROUND
Kenya has approximately 1.5 million people living with HIV, 75% of whom are on antiretroviral therapy (ART). In its work to increase the availability of medicines to all who need them, the Kenyan Ministry of Health (MoH) began transitioning Kenya’s primary ART regimen from a Tenofovir/Lamivudine/Efavirenz (TLE) based treatment to a Dolutegravir (DTG)-based alternative. Given the high number of patients on treatment, the transition to a DTG-based first-line regimen required a comprehensive supply chain transition plan. Kenya was one of the first African countries to distribute a generic version of DTG for routine use among people living with HIV. Tenofovir/Lamivudine/Dolutegravir (TLD) was introduced with the first delivery of the fixed dose combination to the country at the end of 2017.
Following TLD’s introduction in Kenya, the World Health Organization raised concerns over preliminary studies from Botswana that showed there might be an increased risk of neural tube defects in babies born to women on TLD. The National AIDS & STI Control Program (NASCOP) in Kenya revised its ART treatment guidelines in August 2018.
In anticipation of the planned national rollout of TLD, Kenya had already procured significant quantities of TLD. The revised guidelines presented substantial challenges for the planned transition as women of childbearing age account for about 70% of the demand forecast. In addition, procurement of the phased-out regimens was ending.
Given the high number of patients on treatment, the transition to a countrywide DTG-based first-line regimen required a comprehensive supply chain transition plan. NASCOP needed this plan to ensure the adequate availability of appropriate medicines for patients at all levels of healthcare, while minimising the risks of expiry and wastage of stock of expensive ARV medicines. It pointed to the need for a methodology for managing drug regimen changes that NASCOP can enact quickly should similar circumstances arise in future.
ARC’S ROLE
The Africa Resource Centre (ARC) performed an independent advisory role to shape the overall TLD transition project and brokered additional expert resources from Novo Nordisk and a local private sector consultant to support the initiative.
The project refined the current Kenyan supply chain plan for transitioning from TLE to TLD and systematically extracted lessons learned during the transition. The intervention included optimising a phase-in and phase-out period across all stockholding sites, with the complete switchover concluding within the project’s timeframe.
Following the initial scoping of the landscape and understanding the prevailing distribution methods for ART regimens, the team developed a methodology for managing regimen transitions. This methodology included demand and supply planning techniques appropriate to a transition, and consideration of inventory strategy and reverse logistics, leveraging best practice where available.
OUTCOMES AND IMPACT
ARC’s support to ministries of health focuses on strengthening six supply chain elements. The work on the ART transition with NASCOP strengthened three of these six areas: strategy, improvement roadmap, and solutions proposals.
DEVELOPING TOOLS TO FACILITATE COLLABORATION
Key element: strategy
ARC developed a tool to allow NASCOP to simulate scenarios for phasing in new products regularly and evaluate the criteria to guide ongoing supply planning. The tool contributed to the successful development and adoption of a detailed and robust demand and supply planning process.
IMPACT: ARC has further developed the tool to demonstrate scenario modelling functionality which illustrates the benefits of collaborative demand and supply planning processes at a national level.
STRENGTHENING THE SUPPLY CHAIN
Key element: improvement roadmap
This project aimed to build support for product lifecycle planning to strengthen the supply chain operations of the TLD transition in Kenya, and develop new methods and tools applicable to other regimen transitions in the health supply chain in Kenya.
IMPACT: ARC worked with NASCOP to use data and analytics and advocated for changes to established ways of working.
LEVERAGING PRIVATE SECTOR EXPERTISE
Key element: solutions proposals
ARC brokered experts to support the transition and to offer long-term solutions to support supply planning in Kenya.
IMPACT: By including subject matter experts with strong private sector backgrounds, NASCOP gained access to expertise, methods and capability to improve the success of the TLD transition plan.
