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J Lates, 1 B Ongeri, 2 A Wolde , 2 E Sagwa, 2 D Mabirizi 2

THPDE0101. Lessons from the Rapid Response of Namibia’s Supply Chain When Antiretroviral Treatment Guidelines Changed to Tenofovir-based First-line Regimens. J Lates, 1 B Ongeri, 2 A Wolde , 2 E Sagwa, 2 D Mabirizi 2 1 Ministry of Health & Social Services (MoHSS), Namibia

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J Lates, 1 B Ongeri, 2 A Wolde , 2 E Sagwa, 2 D Mabirizi 2

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  1. THPDE0101 Lessons from the Rapid Response of Namibia’s Supply Chain When Antiretroviral Treatment Guidelines Changed to Tenofovir-based First-line Regimens J Lates,1B Ongeri,2 A Wolde,2 E Sagwa,2 D Mabirizi2 1Ministry of Health & Social Services (MoHSS), Namibia 2Partnership for Supply Chain Management System (PFSCM)

  2. Background • Namibia started ART services in 2003 & had rapid roll-out • By Dec 2009 Namibia had 68,000 adults on ART;53% AZT, 34% D4T, 11% TDF • The Electronic Dispensing Tool was introduced in 2006 to optimise management of ART patients and data • Shortage of storage space for ARVS @ CMS & facilities was already being experienced by 2008 • In 2010 national ART guidelines revised • ART eligibility criteria changed CD4 ≤200 to ≤350 • Preferred 1st line regimen changed to TDF • CMS had to rapidly increase stocks of TDF and minimise risk of wastage of d4T and AZT products

  3. Methods • Data on patient enrolment & CD4 levels of pre-ART patients was used to predict the impact of new ART guideline, especially onARV supply chain and ARV expenditure • Purchasing parameters changed to build up stocks of TDF products as a 3 fold increase in TDF demand was expected • CMS warehouses were renovated to increase available racking to handle the increased volume of stocks • Min & max stock levels in Health Facilities were revised down to 4 and 2 months respectively • 3/12 reviews were initiated to monitor consumption trends & stock holdings and pro-actively ensure continuous availability • Intensified tracking of regimen trends to monitor implementation of new guidelines & guidance on improvements to service provision made through quarterly feedback reports

  4. Results • New guidelines additional costs estimated at US$ 3.3 million that Namibian Government pledged to cover • Within 8/12 CMS had accumulated sufficient stock of TDF • New national ART guidelines rolled out Sept 2010 • By Dec 2011 35% of adults on ART were using TDF- c.f. 11% at introduction of new ART guidelines • No stock outs of TDF formulations were reported

  5. Key success factors Acknowledgements • Executive Management of the Ministry of Health and Social Services for leadership and guidance • Staff of the Central Medical Store and all Public Health Facilities for their untiring work in ensuring quality ART services despite their heavy workload • Staff of the USAID funded SCMS and SIAPS projects who provide ongoing support to Pharmaceutical Services • The people of the USA for their generous financial support • Government funding commitment • Availability of accurate data on stock levels, patient numbers & regimens • Flexible procurement system • Integrated supply chain system

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