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 theCTC staff andART patients during stock-outs of drugs and test kits. Methods: This explorative and cross-sectional study was undertaken in September 2011 and involved CDCI and all 11 peripheral CTCs in Kilombero and Ulanga districts in Tanzania. Data were collected through structured interviews with staff in charge of 12 sites and patients onART 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 toART 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

Improved Adherence to Antiretroviral Therapy Observed Among HIV-Infected Children Whose Caregivers had Positive Beliefs in Medicine in Sub-Saharan Africa

A high level of adherence to antiretroviral treatment is essential for optimal clinical outcomes in HIV infection, but measuring adherence is difficult. We investigated whether responses to a questionnaire eliciting caregiver beliefs in medicines were associated with adherence of their child (median age 2.8 years), and whether this in turn was associated with viral suppression. We used the validated beliefs in medicine questionnaire (BMQ) to measure caregiver beliefs, and medication event monitoring system (MEMS) caps to measure adherence. We found significant associations between BMQ scores and adherence, and between adherence and viral suppression. Among children initiating ART, we also found significant associations between BMQ ‘necessity’ scores, and BMQ ‘necessity-concerns’ scores, and later viral suppression. This suggests that the BMQ may be a valuable tool when used alongside other adherence measures, and that it remains important to keep caregivers well informed about the long-term necessity of their child’s ART