Missing the Target #5: Improving AIDS Drug Access ... - CD8 T cells

MOROCCOThe shortage occurred because some drugs planned for 2006 availability couldnot be purchased (FDC of stavudine/lamivudine/nevirapine [d4T/3TC/NVP] andstavudine/lamivudine [d4T/3TC], tenofovir [TDF], and tenofovir/emtricitabine [TDF/FTC]). This resulted in increased consummation of nelfinavir and lopinavir/ritonavirthat was not anticipated. For drugs such as Abbott’s lopinavir/ritonavir combination,which requires refrigeration since the heat-stable formula is still not available,the MoH would stagger the orders. Another reason for the stock-out was theexpectation of renewing the Moroccan proposal to the Global Fund. In prior years,orders were realized by July; this year, because the country was waiting for theGlobal Fund decision, the 2007 order was not submitted on time. Finally, stock-outsmay also be attributed to delays in delivery by the companies: Abbott for Kaletra(LPV/r) and Roche for Viracept (NLF).Fortunately, there were no treatment interruptions. The treatment educators ofthe Moroccan NGO ALCS played a key role organizing sharing of drugs, involvingpeople who had sufficient provisions of ARVs. The MoH and the Global Fundmanagement team ordered exceptional quantities of drugs and pharmaceuticalcompanies were urged to deliver rapidly. ALCS allocated also some of the fundsraised in a TV telethon (Sidaction Maroc 2005) to buy the needed Kaletra (LPV/r).RecommendationsIn order to avoid stock-outs in the future it is recommended that:Planned purchasing should be honoured.MoH and funders like the Global Fund should take into consideration thetransition period between two rounds to ensure the sustainability of thetreatment program.MoH should take into consideration the time required for delivery andpharmaceutical companies should avoid delays in delivery.For the specific case of lopinavir/ritonavir, the delayed introduction of theheat-stable formula with less refrigeration should be addressed.85