session 12: commodity requirements - mz.usembassy.gov · session 12: commodity requirements . 2...
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Process Towards TLD Transition
May 2017 Guidelines
Meeting
November 2017
Stakeholder Consultations
December 2017
DTG implementation plan signed by
Minister of Health
January 2018
1st DTG order placed
5
Process Towards TLD Transition (cont’)
May 2017 Guidelines
Meeting
November 2017
Stakeholder Consultations
December 2017
DTG implementation plan signed by
Minister of Health
January 2018
1st DTG order placed
February 2018
MOH meeting to discuss aggressive TLD transition Plan
6
Aggressive TLD Transition Plan
Phase I: September 2018
Newly Diagnosed Patients
Adverse Drug Reaction (ADR) Patients
Patients on NVP
TB XDR
Patients who abandoned treatment
Phase II: January 2019*
Pregnant Patients
TB Patients
Stable TLE Patients
< 24 months on treatment without viral load suppression
> 24 months on treatment with viral load suppression
*Phase II is contingent on WHO guidelines.
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Lessons Learned from Previous Transitions Applied in the Transition Plan
The 2013 transition to TDF/3TC/EFV faced many challenges:
• Global supply constraints led to treatment interruptions
• Resulting side effects and further miscommunications led to an overall distrust by patients and apprehension about new ARVs
Previous Challenges Highlighted a Need For: TLD Country Response:
Visibility into global supply dynamics Coordinate with global mechanisms and efforts working with
manufacturers
Visibility into distribution and dispensing at
facility and local levels
ePTS and SIGLUS expansion, use, and analysis
Gaps in provider understanding regarding new
ARV
Incorporate previous lessons learned in training modules
Quick identification and response to
implementation challenges
Support MoH in transition management, coordination,
monitoring and evaluating
Establish a Greenline (Linha Verde) and analyze questions
received
Gaps in patient understanding regarding new
ARV
Develop communication and literacy materials
11
TLD Transition Programmatic Concerns
Despite moving forward with an aggressive TLD transition plan and incorporating lessons learned from previous transitions, concerns include:
• Current global supply of TLD is unknown.
• The aggressive nature of phase two leaves little TLE to fall back on in the case of global TLD shortages or delays.
• Challenges regarding discarding stocks of TLE.
• Ensuring WHO guideline approvals will be critical step towards approvals for scale up plans.
12
Commodities: Historical COP Commodity Funding
Historical COP Commodity Budget
COP14 $53
COP15 $49.4
COP16 Includes $14.3 core funds
$62.8
COP17 $58.7M
COP18 $63.8M
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Commodities: COP17 and COP18 Budget
Commodity COP17 Budget COP18 Budget
ARVs $23,357,336 $23,367,729 RTKs $4,464,213 $6,187,446 Viral Load $15,419,179 $25,551,525 EID $4,506,924 $3,561,019 CTX $2,500,000 $661,880 Nutrition $5,000,000 $3,000,000 VMMC $3,506,841 $3,424,620 TOTAL $58,754,493 $65,754,219 Increase over COP17
Budget 11%
PEPFAR Mozambique plans to invest more in commodities in COP18 with a greater proportion to Viral Load.
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Commodity Budget Reflects Greater Investment in Viral Load
The greatest proportion of PEPFAR commodity investments has historically always been in ARVs.
ARV, $23,367,729
Condoms, $-
Labs, $29,112,544
OtherPharma,
$3,661,880
RTK,
$6,187,446
TBHIV, $-
VMMC, $3,424,620
COP18 Commodity Budget by Major Category
ARV
Condoms
Labs
OtherPharma
RTK
TBHIV
VMMC
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Commodity Budget by ARV Sub-Category
$22,675,081
$682,342 $-
$-
$5,000,000
$10,000,000
$15,000,000
$20,000,000
$25,000,000
Adult_ARVs PediatricARVs PMTCT
COP18 Budget by ARV Sub-Category
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Commodity Budget by Labs Sub-Category
85% of VL reagents are procured using a reagent rental approach.
$1,406,168 $-
$22,550,627
$2,081,898 $2,154,851
$- $- $- $- $471,000 $- $448,000
$-
$5,000,000
$10,000,000
$15,000,000
$20,000,000
$25,000,000
COP18 Commodity Budget by Labs Sub-Category
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ARVs: Unmet Financial Need Anticipated for COP19 with Aggressive TLD Transition
FY-18 FY-19 FY-20
94,625,832$ 141,248,533$ 176,500,171$
GF NFM 25,970,934$
New GF Proposal 30,257,795$ 116,248,533$ 46,393,673$
PEPFAR COP15/16 15,039,767$ -$ -$
COP17 * 23,357,336$ -$ -$
COP18 * 23,357,336$
COP19 * 23,357,336$
Needs -$ 1,642,664$ 106,749,163$
3-Year Gap
TX_CURR 1,262,130 1,563,320 2,002,062
ARV Financial Need
108,391,827$
ARVs FY-18 to FY-20
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Supply Chain Partner Performance is on Track and Closely Monitored
• Supply chain partner performance closely monitored and on track
• Percent of deliveries and shipments arrive on time at 95%
• Inventory accuracy at 94%
• Site level stock outs routinely below 5%
• Routine data quality assessments include quarterly End User Verification exercises and data triangulation of consumption and program data
• Frequent routine partner performance management and subsequent changes
• E.g. Redesign of the RTK supply chain processes and procedures to improve RTK availability
• Maintain nationwide stock visibility for all HIV stock
• Electronic system for central, provincial, and district levels updated monthly with plans to move to real-time in COP18
• Paper-based monthly system in service delivery points with expanded implementation of an electronic system (SIGLUS) in COP17 and COP18