16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

INSTITUTIONAL CHALLENGES IN ACCESS TO DRUGS IN DEVELOPING COUNTRIES: AN ANALYSIS OF DRUG FORECASTING AND DRUG CONSUMPTION CAPACITY IN AFRICAN HEALTH CARE INSTITUTIONS

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. ThAb0205

Arnold C.¹, K¨rzinger M.L.¹, Besson M.-H.¹, Sembatya Y.², Ladner J.³, Saba J.^1
1 Axios International, Paris, France, ² Axios International, Kampala, Uganda, ³ Rouen University Hospital, Department of Epidemiology and Public Health, Rouen, France

BACKGROUND: Abbott Laboratories and Boehringer Ingelheim donate Determine® HIV ½ tests and Viramune® respectively for the Prevention of Mother-to-Child Transmission of HIV (PMTCT Donations Program). Pfizer donates Diflucan® for the treatment of Cryptococcal Meningitis and Esophageal Candidiasis (Diflucan® Partnership Program, DPP). A discrepancy between products requested and products used in benefiting institutions was observed in Africa. This retrospective study explores this discrepancy.

METHODS: Applications and biannual progress reports sent by African institutions from July 2000 to November 2005 record institution characteristics, benefiting site numbers, product consumption and order requests. All orders were reviewed and adjusted by external experts. Three ratios were calculated: the Institutional Ordering Performance (IOP=quantities of products used/requested), the Forecasting Ratio (FR=quantities of products recommended/requested) and the Utilisation Rate (UR=quantities of products used/quantities previously received).

RESULTS: 76 institutions in 31 countries were studied (57 receiving Viramune®, 51 receiving HIV tests and 18 receiving Diflucan®). 50% were governmental and 50% non-governmental. Mean institutions follow up was 33 months (median=34). Preliminary results (n=57) showed that 50% of the institutions used less than one quarter of the products requested (IOP<median 0,28). 35% of the institutions had forecast difficulties by overestimating at least one of their product needs (FR<0,5); FR was negatively correlated with an increasing number of participating sites (rs=-0,27; p<0,05). Main reasons were forecasts based on epidemiological figures (55%), poor drug consumption reporting systems (20%), calculation errors (15%), and unrealistic expansion timelines (10%). Half of the institutions (n=29) reported having used less than half of quantities received (UR<0,5). No correlation was found between UR and FR.

CONCLUSIONS: Forecasting challenges are frequent. Adequate forecasts should be projected on drug demand consistent with capacity limitations and not on epidemiological indicators. Uptake of VDP and DPP programs appears to be limited by institutional capacity. Analytical data on institutional capacity will be presented.

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2006-08-13
ThAb0205

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