Title

Barriers to reaching the first 90: A simultaneous, multicountry online survey to identify barriers in HIV rapid test kit service delivery and commodity availability in low- and middle-income countries

Presenter

Mary Lyn Field-Nguer

Authors

A. George¹, J. Heavner², M.L. Field-Nguer³, C. Ndongmo⁴, M. Wattleworth⁵

Institutions

¹USAID Global Health Supply Chain Program - Procurement and Supply Management Project (GHSC-PSM), Health Systems Strengthening - Forecasting and Supply Planning, Atlanta, United States, ²USAID Global Health Supply Chain Program - Procurement and Supply Management Project (GHSC-PSM), Arlington, United States, ³USAID Global Health Supply Chain Program - Procurement and Supply Management Project (GHSC-PSM), Task Order 1 HIV/AIDS, Arlington, United States, ⁴USAID Global Health Supply Chain Program - Procurement and Supply Management Project (GHSC-PSM), Health Systems Strengthening - Lab and VMMC, Arlington, United States, ⁵USAID Global Health Supply Chain Program - Procurement and Supply Management Project (GHSC-PSM), Systems Strengthening - Lab and VMMC, Arlington, United States

Background: In 2017, anecdotal reports indicated site-level stockouts of HIV rapid test kits (RTKs) in several countries. Two projects under the USAID Global Health Program-Procurement and Supply Management (GHSC-PSM) project and Rapid Test Kit (GHSC-RTK) investigated stockout causes, service delivery barriers, and supply chain management challenges in more than 20 countries.
Methods: October 24-November 15, 2017, the two projects simultaneously conducted a qualitative survey in 22 countries. The 47-question survey, which included multiple-choice and open-answer questions, was sent to GHSC-PSM field offices for data collection and response through SurveyMonkey, a cloud-based online survey development service. Answers extracted from SurveyMonkey were cleaned, aggregated, and analyzed by headquarters staff of GHSC-PSM and GHSC-RTK.
Results: Survey analysis highlighted: a) major issues that currently hinder countries'' ability to provide testing services, including poor planning practices (of the 23 percent of countries without established min/max levels, 80 percent have reported stockouts at one or multiple levels in the last two years) and inefficient distribution systems (25 percent of countries use a push model; 14 percent of countries do not have emergency distribution procedures; both systems could help prevent stockouts) and b) correlation between service delivery practice/planning and availability of RTKs at all supply chain levels (58 percent of countries test through unplanned campaigns, of which 43 percent reported stockouts at all levels in the last two years).
Conclusions: This survey was a first in the number of participating countries and the types of data collected, helping identify countries with considerable barriers to reaching the goal of having 90 percent of people with HIV know their status. Results highlighted correlation ? if not causality ? in how service delivery decisions can affect product availability, and ultimately a program''s ability to reach its testing objectives. Finally, the survey is helping partners prioritize countries and systems strengthening interventions, and showed opportunities for service delivery planning and improved communication to help ensure availability of RTKs at testing sites.

[Supply chain components in most need of strengthening to improve RTK availability as identified by GHSC-PSM field offices]