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Stock-outs of antiretroviral and tuberculosis medicines in South Africa: A national cross-sectional survey | Journal Article / Research | MSF Science Portal
Journal Article
|Research

Stock-outs of antiretroviral and tuberculosis medicines in South Africa: A national cross-sectional survey

Hwang B, Shroufi A, Gils T, Steele SJ, Grimsrud A, Boulle AM, Yawa A, Stevenson S, Jankelowitz L, Versteeg-Mojanaga M, Govender I, Stephens J, Hill JE, Duncan K, van Custem G
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Abstract
BACKGROUND
HIV and TB programs have rapidly scaled-up over the past decade in Sub-Saharan Africa and uninterrupted supplies of those medicines are critical to their success. However, estimates of stock-outs are largely unknown. This survey aimed to estimate the extent of stock-outs of antiretroviral and TB medicines in public health facilities across South Africa, which has the world’s largest antiretroviral treatment (ART) program and a rising multidrug-resistant TB epidemic.

METHODS
We conducted a cross-sectional telephonic survey (October—December 2015) of public health facilities. Facilities were asked about the prevalence of stock-outs on the day of the survey and in the preceding three months, their duration and impact.

RESULTS
Nationwide, of 3547 eligible health facilities, 79% (2804) could be reached telephonically. 88% (2463) participated and 4% (93) were excluded as they did not provide ART or TB treatment. Of the 2370 included facilities, 20% (485) reported a stock-out of at least 1 ARV and/or TB-related medicine on the day of contact and 36% (864) during the three months prior to contact, ranging from 74% (163/220) of health facilities in Mpumalanga to 12% (32/261) in the Western Cape province. These 864 facilities reported 1475 individual stock-outs, with one to fourteen different medicines out of stock per facility. Information on impact was provided in 98% (1449/1475) of stock-outs: 25% (366) resulted in a high impact outcome, where patients left the facility without medicine or were provided with an incomplete regimen. Of the 757 stock-outs that were resolved 70% (527) lasted longer than one month.

INTERPRETATION
There was a high prevalence of stock-outs nationwide. Large interprovincial differences in stock-out occurrence, duration, and impact suggest differences in provincial ability to prevent, mitigate and cope within the same framework. End-user monitoring of the supply chain by patients and civil society has the potential to increase transparency and complement public sector monitoring systems.

Countries

South Africa

Subject Area

tuberculosisHIV/AIDSdisease surveillanceaccess to health care

Languages

English
DOI
10.1371/journal.pone.0212405
Published Date
12 Mar 2019
PubMed ID
30861000
Journal
PLOS One
Volume | Issue | Pages
Volume 14, Issue 3, Pages e0212405
Issue Date
2019-03-12
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