Assessing HIV Early Infant Diagnosis Commodity Stock Out Frequency In Selected Public Health Facilities in Zambia

Abstract

Since 2006, low-to medium-income countries in Sub Saharan Africa have been adopting molecular methods for testing for Early Infant Diagnosis (EID) of Human Immunodeficiency Virus (HIV) in infants. Such molecular methods require a number of inputs such as; airconditioned laboratories, training of human resource, regular procurements of reagents and commodities and a robust logistics information management system among other things. Various studies conducted in Low-to Medium-Income Countries (LMIC) have shown that most laboratories in these countries have difficulties providing access to Early Infant Diagnosis of HIV in children. In 2012, 39%of eligible infants in Zambia were not tested for HIV. One reason for this situation was the frequent occurrence of reagent and commodity stock-outs. The frequency of stockouts is a measure of the robustness of the supply chain. This study conveniently selected the following laboratories to assess the frequency of EID reagents stock outs; University Teaching Hospital (UTH) and Centre for Infectious Disease Research in Zambia (CIDRZ) laboratories in Lusaka, Arthur Davison Children’s Hospital (ADCH) laboratory in Ndola and Livingstone central hospital (LCH) laboratory in Livingstone. This was a cross sectional mixed method study. Quantitative data in form of binary data (0 = stock out, 1= in stock) for each day, was collected using a Checklist; the binary data was entered into excel then transferred into Stata13for analysis to obtain Frequencies, Mean stock outs and stock out durations. Quantitative results were presented in form of pie charts and graphs to show the stock fluctuations over the 2-year period. Qualitative data was obtained from in-depth interviews with key informants using a structured interview schedule. Their responses were processed into major themes, sub themes and categories to come up with the various reasons in the EID supply chain which cause stock outs. The study revealed that Stock out frequencies (incidents) for the period of the study (24 months), were few (Mean; 2.4 SD 1.1). However, the durations of the stock out periods were long (30% of 24 months). This translated to the test not being available for reasons of commodity stock outs for 4 months of each year. There were many reasons which led to EID commodity stock outs, prominent amongst which was the non-allocation of funds by the MoH. This created a persistent funding gap which was accentuated by other deficiencies in the supply chain of EID commodities.