1. Washington D.C., USA, 22-27 July 2012www.aids2012.org Lessons from the Rapid Response of Namibia’s Supply Chain When Antiretroviral Treatment Guidelines Changed to Tenofovir-based First- line Regimens J Lates, 1 B Ongeri, 2 A Wolde, 2 E Sagwa, 2 D Mabirizi 2 1 Ministry of Health & Social Services (MoHSS), Namibia 2 Partnership for Supply Chain Management System (PFSCM) THPDE0101

2. Washington D.C., USA, 22-27 July 2012www.aids2012.org Background Namibia started ART services in 2003 & had rapid roll-out By Dec 2009 Namibia had 68,000 adults on ART; 53% AZT, 34% D4T, 11% TDF The Electronic Dispensing Tool was introduced in 2006 to optimise management of ART patients and data Shortage of storage space for ARVS @ CMS & facilities was already being experienced by 2008 In 2010 national ART guidelines revised –ART eligibility criteria changed CD4 ≤200 to ≤350 –Preferred 1 st line regimen changed to TDF CMS had to rapidly increase stocks of TDF and minimise risk of wastage of d4T and AZT products

3. Washington D.C., USA, 22-27 July 2012www.aids2012.org Methods Data on patient enrolment & CD4 levels of pre-ART patients was used to predict the impact of new ART guideline, especially on ARV supply chain and ARV expenditure Purchasing parameters changed to build up stocks of TDF products as a 3 fold increase in TDF demand was expected CMS warehouses were renovated to increase available racking to handle the increased volume of stocks Min & max stock levels in Health Facilities were revised down to 4 and 2 months respectively 3/12 reviews were initiated to monitor consumption trends & stock holdings and pro- actively ensure continuous availability Intensified tracking of regimen trends to monitor implementation of new guidelines & guidance on improvements to service provision made through quarterly feedback reports

4. Washington D.C., USA, 22-27 July 2012www.aids2012.org Results New guidelines additional costs estimated at US$ 3.3 million that Namibian Government pledged to cover Within 8/12 CMS had accumulated sufficient stock of TDF New national ART guidelines rolled out Sept 2010 By Dec 2011 35% of adults on ART were using TDF- c.f. 11% at introduction of new ART guidelines No stock outs of TDF formulations were reported

5. Washington D.C., USA, 22-27 July 2012www.aids2012.org Key success factors Acknowledgements Executive Management of the Ministry of Health and Social Services for leadership and guidance Staff of the Central Medical Store and all Public Health Facilities for their untiring work in ensuring quality ART services despite their heavy workload Staff of the USAID funded SCMS and SIAPS projects who provide ongoing support to Pharmaceutical Services The people of the USA for their generous financial support Government funding commitment Availability of accurate data on stock levels, patient numbers & regimens Flexible procurement system Integrated supply chain system