New research has revealed stock-outs of pediatric ART drugs in Uganda (74.7percent) and Kenya (40 percent).
According to the report titled availability and stock outs of pediatric treatment formulations at health facilities in Kenya and Uganda the two east African Countries faces challenges by health ministries in quantification, supply planning, and stock management of pediatric ART.
“Ensuring the availability of pediatric antiretroviral treatment is vital for reducing HIV-related mortality among children and improving their quality of life. This study provides a comprehensive overview of the current challenges in Kenya and Uganda, emphasizing the urgent need for systemic changes to ensure that no child is left without the life-saving medication they need.”
The study revealed that availability of recommended dolutegravir (DTG)-based first-line antiretroviral therapy (ART) for children across all ages was reasonably sufficient at public health facilities in Uganda and Kenya.
The study revealed that in Kenya 52.2 percent of facilities had preferred pediatric ART formulations, while in Uganda, the availability was slightly higher at 63.5 percent.
Specific formulations like dolutegravir (DTG) 10 mg dispersible tablets were available in 70.2 percent of Kenyan facilities and 77.4 percent of Ugandan facilities. Abacavir lamivudine dispersible tablets had higher availability, at 89.8 percent in Kenya and 98.2 percent in Uganda.
The availability of pediatric limited-use products was extremely low, at 1.1 percent in Kenya and 1.9 percent in Uganda, indicating a severe gap in the supply of essential medications for children who need alternative or phased-out treatment options.
“Antiretroviral stock-outs negatively impact treatment by causing delays, interruptions, and increased risks of resistance, “the study says in part adding that, “DTG-based first-line ART for children is reasonably available, stock-outs and availability issues for pediatric formulations are concerning, necessitating better forecasting and supply chain.”
The study says that forecasting challenges led to stock-outs of key formulations, such as lopinavir LPV/r, which was the most commonly used regimen among children aged 0-14 years living with HIV in 2021.
In particular, the transition to optimal pediatric ART formulations, like DTG dispersible tablets, has been slow in regions that have not fully adopted these new standards.
The study also points out that newer ART formulations, such as ritonavir-boosted darunavir (DRV/r), show promise for use in children. However, their current high cost and lack of guidelines on pediatric use limit their accessibility.
Additionally, high rates of stock-outs for certain preferred pediatric formulations, such as lopinavir LPV/r tablets and granules/pellets, as well as nevirapine (NVP) oral solution, were reported. These stock-outs are particularly problematic, given the use of these formulations for postnatal HIV prophylaxis.
The research also found out issues such as need for dose escalation with body weight, lack of child-appropriate formulations, and the palatability of pediatric drugs as a major challenge with pediatric ART formulations.
The study underscores the need for well-supported stock management systems and differentiated service delivery (DSD) to address the issues of stock-outs and improve long-term retention in HIV care. By reducing barriers to accessing ART and focusing on child-appropriate formulations with good palatability, significant strides can be made in enhancing the quality of life for children living with HIV.
“Improving the forecasting of drug needs, enhancing coordination among supply chain stakeholders, and securing adequate funding are essential steps to mitigate these issues. Additionally, expanding the availability of child-appropriate formulations and ensuring that healthcare facilities are well-stocked can significantly improve treatment outcomes for children living with HIV.”
Globally, an estimated 1.7 million children under 14 were living with HIV in 2021, with significant populations in Kenya and Uganda. Despite a reduction in new infections due to effective prevention measures, pediatric HIV remains a significant concern, particularly because children have a lower rate of antiretroviral treatment coverage compared to adults.
The study aimed to assess the availability and stock-outs of both pediatric and adult ART formulations in health facilities across various regions of Kenya and Uganda, providing a comprehensive overview of the situation.
Health Action International-WHO Medicine Availability Monitoring Tool. Data collection took place in June-July 2022 and covered both public and private-not-for-profit (PNFP) health facilities in six districts per country. It entailed all preferred and limited-use formulations according to the 2021 WHO optimal formulary list, as well as select adult ART formulations suitable for older children and adolescents.
The study included 144 health facilities (72 per country), comprising 110 public and 34 PNFP facilities.
The findings revealed significant gaps in the availability of pediatric ART formulations.
