An assessment of the supply chain management for HIV/AIDS care and treatment in Kilombero and Ulanga districts in southern Tanzania

Background: The Chronic Diseases Clinic Ifakara (CDCI) has been providing HIV care and treatment in Kilombero and Ulanga districts in Tanzania since 2005. Over time, several drug-refilling stations were created through the Tanzanian National AIDS Control Programme (NACP) to provide antiretroviral therapy (ART). Without any specific performance and outcome evaluation, these refilling stations were upgraded to comprehensive HIV care and treatment centres (CTCs). The objectives of this study were to evaluate the supply chain of the CTCs, key aspects of patient management and the coping strategies of the CTC staff and ART patients during stock-outs of drugs and test kits.
Methods: Data were collected through structured interviews with staff in charge of 12 sites and patients on ART during un-announced visits.
Results: All sites reported shortage of rapid tests to diagnose HIV. Seven (59%) CTCs experienced stock-outs of co-trimoxazole drugs. The CDCI and all but one peripheral CTC reported stock-outs of ARV medication. CD4 + T cell count service and second line drugs were available at the CDCI and in two CTCs only. To cope with the stock-out situation CTCs staff had to stop testing for HIV, substitute the treatment regimen depending on drug availability or close the CTC temporarily. Patients coped by skipping ARVs and co-trimoxazole medications.
Conclusion: Access to ART in Kilombero and Ulanga districts has some critical imbalances in the supply chain and management for HIV/AIDS care and treatment. Potential strategies to overcome the barriers are discussed in relation to routine health management information system, investments into mobile-health and human resource capacity strengthening.