Additional file 1: of Combined interventions to reduce HIV incidence in KwaZulu-Natal: a modelling study

Technical appendix and supplementary results. (PDF 639 kb

Stockouts of HIV commodities in public health facilities in Kinshasa: Barriers to end HIV

<div><p>Stockouts of HIV commodities increase the risk of treatment interruption, antiretroviral resistance, treatment failure, morbidity and mortality. The study objective was to assess the magnitude and duration of stockouts of HIV medicines and diagnostic tests in public facilities in Kinshasa, Democratic Republic of the Congo. This was a cross-sectional survey involving visits to facilities and warehouses in April and May 2015. All zonal warehouses, all public facilities with more than 200 patients on antiretroviral treatment (ART) (high-burden facilities) and a purposive sample of facilities with 200 or fewer patients (low-burden facilities) in Kinshasa were selected. We focused on three adult ART formulations, cotrimoxazole tablets, and HIV diagnostic tests. Availability of items was determined by physical check, while stockout duration until the day of the survey visit was verified with stock cards. In case of ART stockouts, we asked the pharmacist in charge what the facility coping strategy was for patients needing those medicines. The study included 28 high-burden facilities and 64 low-burden facilities, together serving around 22000 ART patients. During the study period, a national shortage of the newly introduced first-line regimen Tenofovir-Lamivudine-Efavirenz resulted in stockouts of this regimen in 56% of high-burden and 43% of low-burden facilities, lasting a median of 36 (interquartile range 29–90) and 44 days (interquartile range 24–90) until the day of the survey visit, respectively. Each of the other investigated commodities were found out of stock in at least two low-burden and two high-burden facilities. In 30/41 (73%) of stockout cases, the commodity was absent at the facility but present at the upstream warehouse. In 30/57 (54%) of ART stockout cases, patients did not receive any medicines. In some cases, patients were switched to different ART formulations or regimens. Stockouts of HIV commodities were common in the visited facilities. Introduction of new ART regimens needs additional planning.</p></div

Number and duration of stockouts of HIV commodities in public health facilities, Kinshasa 2015.

<p>TDF-3TC-EFV: Tenofovir/Lamivudine/Efavirenz 300/300/600 mg tablets, 30 tablets. AZT-3TC-NVP: Zidovudine/Lamivudine/Nevirapine 300/150/200 mg tablets, 60 tablets. TDF-3TC: Tenofovir/Lamivudine 300/300 mg tablets, 30 tablets. CTX: Sulfamethoxazole/Trimethoprim 400/80 mg, tablets. HIV test: Determine^TM HIV-1/2 Test Kits.</p

Selection of public health facilities and numbers of patients on ART, Kinshasa 2015.

<p>(a) Antiretroviral treatment (ART) facilities in Kinshasa. Out of 35 existing health zones in Kinshasa, the two zones managed by the police and the military, serving 1187 patients, were excluded before analysis. (b) ART facilities included in the study. All high-burden facilities were targeted, and a purposive sample of low-burden facilities, including for each health zone the largest facility with 100–200 patients and the largest facility with < 100 patients.</p

Percentage of facilities with number of HIV commodities out of stock, Kinshasa 2015.

<p>Percentage of facilities with number of HIV commodities out of stock, Kinshasa 2015.</p

Interview Topic Guide.

<p>Interview Topic Guide.</p

Interview Topic Guide.

<p>Interview Topic Guide.</p

Socio-demographic characteristics of research participants.

<p>Socio-demographic characteristics of research participants.</p

Additional file 2: of Progress towards the UNAIDS 90–90-90 goals by age and gender in a rural area of KwaZulu-Natal, South Africa: a household-based community cross-sectional survey

Mbongolwane survey Women questionnaire: questions to the individual female participants. (PDF 63 kb

Essential program components of Médecins Sans Frontières Chagas disease diagnosis and treatment projects in Central and South America, 1999–2008.

<p>Essential program components of Médecins Sans Frontières Chagas disease diagnosis and treatment projects in Central and South America, 1999–2008.</p