Harmonization of donor reporting requirements for antiretrovirals and related drugs Presented at the WHO meeting, Geneva ( October 2005) Oteba Olowo Martin

Presentation outline Background on ART Monitoring HIV Medicines Supply Information exchange for HIV/AIDS treatment programme Achievements Challenges

Background Population living with HIV/AIDS 1 – 1.2 million people Population in need of ART 100,000 – 120,000 The 3x5 target 60,000 patients

Background - 2 Treatment of HIV/AIDS started as early as 1992 through the JCRC Currently more partners involved JCRC, CDC, Uganda Cares, MSF, CRS, Uganda Business Coalition, TASO, NGOs and Faith-Based hospitals, GoU health facilities A total of 175 facilities Accredited GoU:- 99, PFP + PNFP:- 76

Background - 3 MOH – (World Bank/MAP + GFATM) free, some lab/consulting fees, mostly generic drugs first line JCRC - paying, generic & branded, free pediatric drugs, free for pregnant women 2005 Existing NGOs - MSF,GTZ,Columbia, free, mainly generic

Background - 4 PEPFAR NGOs - CRS, TASO, Mildmay, CDC IRCU free, branded Uganda Business Coalition - paying, branded Private Providers - paying, generic + branded

Recommended Regimens: Adults and Children 1 st line2 nd linecomments ZDV + 3TC + NVP or EFZ d4T +ddI + LPV/R Dose adjusted for children by wt and age d4t + 3TC + NVP or EFZ ZDV/ddI + LPV/r

What is monitored Number of patients legible to start ART Uptake of ARV and testing requirements by month HIV/AIDS Medicines stock at central and facility levels; Months of stock, value worth, shelf life

What is reviewed Months of stock, shelf life and monthly uptake (monthly) reviewed to ensure availability of sufficient ARVs at national level Adherence to Scheduled monthly distribution to the treatment centers by the central supply agency – National Medical Stores (NMS) Changes in uptake and utilization patterns (patient numbers and switching of regimens from 1 st to second line treatments)

Information exchange for HIV/AIDS treatment programme Patient numbers, ARV uptake and pattern of utilization (1 st line Vs 2 nd line treatments) Drop out rate and deaths, adverse reactions (still weak though)

Inter relationships within the medicines supply system in Uganda Health programmes National Medical stores (NMS) Health Facilities PEPFAR NGO Delivery information JMS Donors

Achievements People under ART treatment (current) about 67,000 GoU - 14,000 PEPFAR support – 10,000 JCRC – 26,000 Other NGOs – 6,000 UBC – 3,000 Private Sector – 8,000 Public – Private links strengthened

Challenges Getting people PLWHA on board as required HR Capacity Infrastructure capacity Patient monitoring Pharmacovigilance

Challenges.. (2) Coordination of partners at all levels and integration of medicines and supplies systems Guarantee of commitments by the various players (uncertainty over the long term funding to sustain un overly escalated programme) – GFATM suspension?? For instance. Inadequate transparency among players (inputs $) affecting appropriate planning and ultimately information flow Implementation of pharmacovigilance

Recommendations related to ARV and related supplies Need for donors to support and facilitate integrated medicines and supplies systems in countries to achieve meaningful harmonization and sustainability of reporting mechanisms. Need to include resource inputs ($) for procurement of ARVs, test kits etc, level of commitment and duration of commitment if the ART programmes have to be realistically sustained.