Harmonization of donor reporting requirements for antiretrovirals and related drugs

1. Harmonization of donor reporting requirements for antiretrovirals and related drugs Presented at the WHO meeting, Geneva (10 - 11 October 2005) Oteba Olowo Martin

2. Presentation outline • Background on ART • Monitoring HIV Medicines Supply • Information exchange for HIV/AIDS treatment programme • Achievements • Challenges

3. Background • Population living with HIV/AIDS 1 – 1.2 million people • Population in need of ART 100,000 – 120,000 • The 3x5 target 60,000 patients

4. Background - 2 • Treatment of HIV/AIDS started as early as 1992 through the JCRC • Currently more partners involved • JCRC, CDC, Uganda Cares, MSF, CRS, Uganda Business Coalition, TASO, NGOs and Faith-Based hospitals, GoU health facilities • A total of 175 facilities Accredited • GoU:- 99, PFP + PNFP:- 76

5. Background - 3 • MOH – (World Bank/MAP + GFATM) free, some lab/consulting fees, mostly generic drugs first line • JCRC - paying, generic & branded, free pediatric drugs, free for pregnant women 2005 • Existing NGOs - MSF,GTZ,Columbia, free, mainly generic

6. Background - 4 • PEPFAR NGOs - CRS, TASO, Mildmay, CDC IRCU free, branded • Uganda Business Coalition - paying, branded • Private Providers - paying, generic + branded

7. Recommended Regimens: Adults and Children

8. What is monitored • Number of patients legible to start ART • Uptake of ARV and testing requirements by month • HIV/AIDS Medicines stock at central and facility levels; • Months of stock , value worth, shelf life

9. What is reviewed • Months of stock, shelf life and monthly uptake (monthly) reviewed to ensure availability of sufficient ARVs at national level • Adherence to Scheduled monthly distribution to the treatment centers by the central supply agency – National Medical Stores (NMS) • Changes in uptake and utilization patterns (patient numbers and switching of regimens from 1st to second line treatments)

10. Information exchange for HIV/AIDS treatment programme • Patient numbers, ARV uptake and pattern of utilization (1st line Vs 2nd line treatments) • Drop out rate and deaths, adverse reactions (still weak though)

11. Inter relationships within the medicines supply system in Uganda Health programmes Donors PEPFAR Delivery information JMS NGO National Medical stores (NMS) Health Facilities

12. Achievements • People under ART treatment (current) about 67,000 • GoU - 14,000 • PEPFAR support – 10,000 • JCRC – 26,000 • Other NGOs – 6,000 • UBC – 3,000 • Private Sector – 8,000 • Public – Private links strengthened

13. Challenges • Getting people PLWHA on board as required • HR Capacity • Infrastructure capacity • Patient monitoring • Pharmacovigilance

14. Challenges.. (2) Coordination of partners at all levelsand integration of medicines and supplies systems Guarantee of commitments by the various players (uncertainty over the long term funding to sustain un overly escalated programme) – GFATM suspension?? For instance. Inadequate transparency among players(inputs $) affecting appropriate planning and ultimately information flow Implementation of pharmacovigilance

15. Recommendations related to ARV and related supplies • Need for donors to support and facilitate integrated medicines and supplies systems in countries to achieve meaningful harmonization and sustainability of reporting mechanisms. • Need to include resource inputs ($) for procurement of ARVs, test kits etc, level of commitment and duration of commitment if the ART programmes have to be realistically sustained.

16. thank you