Process Evaluation of Antiretroviral (ARV) Drug Supply Management of Antiretroviral Therapy (ART) sites in Ethiopia

Abstract

Background: Ethiopia is severely affected by HIV/AIDS. According to the 2006 sentinel surveillance report the number of PLWHA was estimated 1.32 million. The country has launched ART for paying patients since July 2003 and then free access ART 2004-2008, with the help of Global fund, PEPFAR and others, since Jan. 2005 as an element of comprehensive care and support for PLWHA. Effective ARV drug supply management is indispensable for the success of ART program as it ensures an uninterrupted supply of ARV drugs and their proper use. This process evaluation of ARV drug supply management has been done in accordance with recommendation of evaluability assessment and an agreement with stakeholders. Objective: The objective of the evaluation is to assess the level of implementation of the various functions of the drug supply management of ART sites; to identify strength and inadequacies; make generalization and provide the findings of the evaluation to stakeholders for improvement. Methods: The evaluation is process evaluation and designed as facility base cross sectional survey that focuses on the assessment of level of implementation of the various components of ARV drug supply management including availability of plan, guidelines, SOPs and their compliance at ART sites including at stakeholders: FMOH/PSLD, DACA, RHBs, and MSH/SCMS/RPM- plus level. The evaluation was conducted after getting ethical clearance, organizing stakeholder meeting and defining standard parameters for judging the level of implementation. The data for the evaluation were collected by trained pharmacists using structured and field tested questionnaires from the 20 ART sites, sampled from the 56 ART sites that have been providing ART service for more than one year in the country, and 60 experts from ART sites, 7 RHBS, DACA, MOH/PSLD, MSH/SCMS/RPM-plus from Oct to Nov. 15 2007. Confidentiality and privacy of Experts interviewed and institutions were maintained. Quantitative data were analyzed using Epi info version 3.3.2 and qualitative data were analyzed thematically and resulted were presented in narrative form. Findings were rated against the standard parameter and presented in table. Results: No ART site and RHBs were found having plan of action for the budget including any function of ARV drug supply management. Average percentages availability and use of SOP formats in ART sites were 82% and 57.75 % respectively. No ART site was found estimating and sending its annual ARV drugs requirement. Only 10% and 50 % of ART sites were having procurement time table and using Standardized Requisition formats respectively. Stores and dispensaries of ART sites were found to meet average score criteria 8/10 (80%) and 7.9/9 (85%) respectively. Average percentage availability and stock out of ARV drugs with and without ZDV were 90 -95% and 0.71 -1.96% respectively. Average percentage of Stock cards corresponding to physical count was 18.29%. 90% of ART sites used at least one mechanism to control expiration of ARV drugs. Percentage of over all compliance with standard prescription writing by prescribers was 77.41% with very low (16.38%) in writing of address of patients. 90 %, 40%, 50% and 100% of the ART sites’ dispensaries were found having separate counseling place, patient tracking system, using stock movement card, and staffed with trained pharmacy personnel respectively. None of the ART site had counseling guideline ART sites were found on the average complying with 80%, 88%, and 91.13% criteria for good dispensing practice, recording, and reporting of dispensed ARV drugs respectively. No ART sites were found undertaking internal monitoring of their ARV drug pharmacies and providing feed back accordingly. The findings of evaluation of RHBs, MOH/PSLD, DACA, and MSH/SCM strengthened the findings of ART sites. The over all finding of the evaluation has shown that ARV drug supply management of ART sites is functioning at medium level (medium performance, 72.79%). Conclusion: The over all implementation of ARV drug supply management of ART sites in Ethiopia is rated as medium performance (72.79%)The evaluation finding showed various strengths that need to be build up and inadequacies that should be addressed as per the recommendation by ART sites, RHBs, MOH, DACA, MSH/SCMS and others individually and in collaboration