Session 12: Commodity Requirements

2

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

3

World Health Organization 1st Line ART Drugs include DTG

DTG!

4

Currently Mozambique 1st Line ART does not include DTG

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.

7

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

8

TLD: Transition Timed to Minimize Stock Wastage

9

TLD: Phased Transition Accounts for Previous Lessons Learned and Viral Load Constraints

10

TLD: Transition Plans Incorporate Growth of Buffer Stock

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

13

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.

14

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

15

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

16

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

17

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

18

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