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The Web-Based ARV Ordering and Reporting System (WAOS) is the official Ministry of Health (MoH)

ARV ordering and reporting system hosted within the District Health Information Software (DHIS2).

Since 2014, the Ministry of Health has used this system to support health facilities to order and

report on utilistion of ARVs and medicines for treatment of opportunistic infections.

The web –based orders are submitted at different levels of the health service delivery system .

Healthfacilities with computers and internet connectivity submit orders directly in to the web-based

system. Facilities without computers and internet connectivity submit hard copies of the orders to

the district and with the support of the district biostatisticians, these orders are transcribed into the

Web based system. In addition, hard copy orders may be submitted to the warehouses/regional

offices that are inturn entered in to the web bases sytem.

The WAOS bimonthly report highlights facility reporting rates, patient numbers and stock status of

key indicator ARV medicines. The report provides recommendations that require action from various

stakeholders. Detailed analysis of facility stock status highlights order quality issues, stockout and

overstocked commodities.

Report highlights

A total of 1,661 facilities submitted an order/report this cycle, representing 96% of the 1,734

ART sites that have been active for the last one year

About 95% of the reports were submitted through WAOS

About 62% of facilities submitted order before/by order deadline. This is still considered low as

many facilities stand a risk of stock out and late supply by the respective warehouse.

A total of 93% of the facilities that ordered reported on stock status of TDF/3TC/EFV

300mg/300mg/600mg. The percentage of facilities that reported a stock out of TDF/3TC/EFV

at the end of April –May cycle has reduced to 4% compared to 12% in the previous cycle.

Most of the pediatric formualtions were to be over stocked at the health facilities including

Zidovudine/Lamuvudine 60mg/30mg, Zidovudine/Lamuvudine/Nevirapine 60mg/30mg/50mg

and Abacavir/Lamuvudine 60mg/30mg.

Patient numbers reported in HMIS reports were 9% lower than WAOS reported patient numbers.

The variation was mostly attributed to adult patient numbers while there was no significant

variation in the first line pediatric patient numbers reported in both the HMIS and WAOS reports.

Web-Based ARV Ordering and Reporting

System (WAOS) Report April 2017 – May 2017

Uganda Ministry of Health | STD/AIDS Control Programme| P.O. Box 7272 | Kampala | Uganda

Phone: +256-414-4257409 | Contact:pachii@msh.org |Website: www.health.org.ug

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There is need to continuously support facilities to ensure complete, accurate and harmonized

reporting of patient numbers in both HMIS and WAOS reports.

Use of the system

a) Reporting rates and timeliness of reporting.

Reporting rates were analyzed based on active ART facilities as of May 2017. These include facilities

that submitted at least one order/report in the last twelve months. The number of active facilities is

1,734 facilities. The overall reporting rate in this period is at 96% while timeliness of order

submission is at 62%. Overall timeliness of order submission was affected by the low timeliness in

the private for profit facilities which is still at 22%. A detailed analysis of each sector for the selected

indicators are shown in table 1 below.

Table 1: Status of Reporting by category

Reporting rates by facility type

FACILITY OWNERSHIP ALL SITES (TOTAL)

GOVERNMENT MEDICAL BUREAUS

NGO PNFP PRIVATE

FOR PROFIT

Number of active ART sites as per the Master List Oct 14 1,770 1,238 257 169 108

Number of active ART sites Feb 2016 – May 2017 1,734 1,244 257 143 90

% that reported this cycle 96% 94% 99% 99% 100%

% that reported through WAOS 95% 99% 84% 82% 99%

% that ordered/reported by warehouse deadline 62% 65% 67% 52% 22%

% that reported patient data 96% 98% 95% 93% 74%

b) Reporting rate by warehouse / supplier

Table 2 shows overall reporting rates for facilities receiving supplies from NMS, JMS and MAUL over

the past seven cycles. overall reporting rate has remained at 96% of the active ART site

Table 2:WAOs warehouse reporting rates and reported patient numbers

Active ART Facilities No. Reporting Reporting rates *Patient Numbers

Overall 1,736 1,661 96% 1,066,595

JMS 291 290 100% 103,185

MAUL 199 199 100% 266,634

NMS 1,246 1,172 94% 696,776

*Patient numbers as reported in WAOS April-May 2017

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Figure 1: Overall reporting rates across all three central warehouses for the last one year

As seen in Fig.1 above, Medical access has generally maintained stable reporting rate across the

period. JMS has registered significant improvement while NMS has declines from 97% in tbe

previous cycle to 94%.

b) Facility stock status

Table 3 shows the overall stock status of medicines at facilities during the reporting period. Generally,

many facilities reported an overstock of adult formulations while some few reported stock outs of

the adult formulations. A detailed review of TDF/3TC/EFV stock status show that, 25% had over 4

months of stock, 33% had between 2 and 4 months of stock, 38% had less than 2 MOS but greater

than 0 months of stock on hand. At a national AMC of 424,853 additional , 2 months of stock ( Approx

840,000 packs eqv to $ 7.3M) are required to increase the stock levels to 4 months of stock in all the

facilities that were both below 2 and at 0 months of stock. The excess stock available in the facilities

with stock above 4 months of stock was equivalent to 0.3 months of stock.( Refer to table 3 )

Similarly, many facilities reported an overstock of majority of the pediatric formulations . Specific to

Lopinavir/ritonavir suspension, facilities reported a national AMC of 1,434. Therefore, an additional

3.3 months of stock are required to attain the desired stock levels of 4 months of stock in facilities

that reported stock levels below 2 MOS. Redistribution during this cycle may not work for LPV/r

since excess stock was equivalent to only 0.1 months of stock. In addition, the 2016 HIV consolidated

guidelines reccommends replacement of LPV/r suspension with LPV/r pellets for use in children

below the age of three years. Health facilities are expected to order for this product inorder to

facilitate smooth transistion.

A detailed facility stock status report will be shared with the districts and IP inorder to guide stock

redistribution and minimize stock outs and expiries.

97% 94%

99%100%

100% 100%

0%

20%

40%

60%

80%

100%

120%

A P R - M A Y 2 0 1 6

J U N - J U L 2 0 1 6

A U G - S E P 2 0 1 6

O C T - N O V 2 0 1 6

D E C - J A N 2 0 1 7

F E B - M A R 2 0 1 7

A P R - M A Y 2 0 1 7

W AR EH O USE R EP O RT ING R AT ES

NMS JMS MAUL

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Figure 2: Trends in TDF/3TC regimens’ average monthly consumptions

The percentage of patients on TDF/3TC/EFV contributing to the total number of patients on TDF

based regimens has increased (from 82% to 85% since June 2016). Howerver the low stocks for

TDF/3TC/EFV in the country in the past months ending 2016 and at the beginning of 2017 led to an

increase in the use of TDF/3TC combined with EFV to substitute for TDF/3TC/EFV as reflected in

increased TDF/3TC AMCs. This substitution should be carefully coordinated to ensure that stock for

patients in need of TDF/3TC and NVP or TDF/3TC with LPV/r are not depleted. In addition,

consumption reports for substituted products should be well aligned to avoid over and under

reporting for respective formulations

-

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

500,000

Jul 2016 Sep 2016 Nov 2016 Jan 2017 Mar 2017 May 2017

AM

C

TDF based regimen AMCs

Tenofovir/Lamivudine (TDF/3TC) 300mg/300mg

Tenofovir/Lamivudine/Efavirenz 300mg/300mg/600mg

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Table 3; Facility Stock Status as of 1st June 2017

Facility Stock Status

Category Months of stock : Min 2-Max 4

No of

facilities 0 MoS 0.1-2 MoS

2.1-4 MoS >4 MoS

WAOS Facility AMC

- National

Additional stock

required

Excess stock ( For possible

redistribution )

Adult

Abacavir/Lamivudine (ABC/3TC) 600mg/300mg 533 19% 20% 19% 42% 12,848 1.9 2.1

Atazanavir/ritonavir (ATV/r) 300mg/100mg 701 4% 21% 26% 50% 19,453 1.8 1.6

Efavirenz (EFV) 600mg 1,248 3% 22% 21% 54% 150,718 1.7 1.7

Lopinavir/Ritonavir (LPV/r) 200mg/50mg 617 8% 22% 24% 46% 19,279 1.8 0.8

Nevirapine (NVP) 200mg 1,124 4% 18% 22% 57% 68,016 1.4 2.1

Tenofovir/Lamivudine (TDF/3TC) 300mg/300mg 1,295 4% 24% 22% 50% 181,841 1.8 1.4

Tenofovir/Lamivudine/Efavirenz 300mg/300mg/600mg 1,546 4% 38% 33% 25% 424,853 2.0 0.3

Zidovudine (AZT) 300mg 12 8% 25% 8% 58% 142 0.9 6.8

Zidovudine/Lamivudine (AZT/3TC) 300mg/150mg 1,120 3% 21% 22% 54% 82,729 1.6 1.8

Zidovudine/Lamivudine/Nevirapine 300mg/150mg/200mg 1,393 3% 26% 32% 40% 209,983 1.6 0.8

Pediatric

Abacavir (ABC) 60mg 13 38% 31% 23% 8% 90 3.2 7.2

Abacavir/Lamivudine (ABC/3TC) 60mg/30mg 1,090 5% 20% 24% 51% 43,761 1.6 2.3

Efavirenz (EFV) 200mg 785 12% 20% 17% 51% 9,294 1.7 3.4

Lopinavir/Ritonavir (LPV/r) 100mg/25mg 369 9% 22% 18% 51% 7,905 2.0 2.7

Lopinavir/Ritonavir 80/20ml oral syrup 25 20% 16% 32% 32% 1,434 3.3 0.1

Nevirapine (NVP) 10mg/ml oral susp. 1,139 11% 18% 18% 53% 6,140 1.7 3.5

Nevirapine (NVP) 50mg 551 22% 26% 18% 34% 13,527 1.9 1.3

Zidovudine/Lamivudine (AZT/3TC) 60mg/30mg 545 6% 14% 15% 64% 11,606 1.3 9.5

Zidovudine/Lamivudine/Nevirapine 60mg/30mg/50mg 1,168 5% 21% 24% 50% 47,644 1.0 3.3

OIs

Fluconazole 200mg 707 17% 24% 17% 42% 5,053 2.1 6.8

Fluconazole IV 97 19% 18% 14% 49% 1,082 2.2 6.5

Fluconazole oral solution 146 17% 10% 14% 58% 621 1.7 12.7

Cotrimoxazole 120mg 1,276 14% 20% 21% 45% 4,696 1.9 2.4

Cotrimoxazole 960mg 1,495 6% 27% 35% 31% 27,215 1.7 0.7

Dapsone 100mg 487 20% 13% 27% 40% 3,918 2.1 9.2

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Patient statistics

These patient statistics are based on all active ART facilities that reported on patient numbers in the last two cycles

ending May 31 2017. The patient numbers are from reports submitted through WAOS as well as paper and other

electronic orders/reports submitted to the warehouses.

a) Patient numbers reported in the public and private sector as of 1st June 2017

Table 4 presents a summary of WAOS reported patient numbers compared to patient numbers as reported in

DHIS2/HMIS reports. The overall ACP patients are 9% lower than the WAOS reported numbers. ACP patient

numbers on adult 1st line regimens were 9% lower than WAOS reported numbers while pediatric 1st line patients

were almost similar to those reported in WAOS.

Table 4: Patient numbers in both the private and public sector

Current number of ART patients ACP 31st March 2017 WAOS 1st June 2017 % Difference

Total number of ART patients 980,615 1,066,595 -9%

Total Adult ART patients 915,528 1,000,425 -9%

Total Pediatric ART patients 65,087 66,170 -2%

Number of Adults on 1st Line 884,689 965,012 -9%

Number of Adults on 2nd Line 30,839 35,413 -15%

Number of Children on 1st Line 59,786 59,766 0%

Number of Children on 2nd Line 5,301 6,404 -21%

Next Steps

The district together with IPs to support facilities to redistribute ARVs that are over stocked with a focus on

Nevirapine 50mg tablet and Nevirapine suspension

District and IPs to support health facilities to order for LPV/r pellets inorder to facilitate smooth transition

District Biostiatisticans to support health facilities to provide accurate patient number information

Bistatisticians should review data entered in WAOS before submission to minimize data entry errors

IPs supporting the private sector should focus on ensuring facilities submit orders in a timely manner

Ministry of health and UHSC will facilitate training on the new Web based ordering system and ARV order and

report form

IP to print and ensure dissemination of the June 2017 verison of the ARV and OI order and report forms

IPs to prioritise training of Logistics officers during the roll out and dissemination of the 2016 HIV consolidated

guidelines

APPENDIX

A detailed facility level stock status report to help facilitate stock redistribution was shared with all The DHOs,

Implementing Partners, Regional Pharmaceutical Monitoring Teams, and Medicines Management Supervisors