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Zimbabwe Antiretroviral Therapy Program: Issues and Opportunities for Initiation and Expansion

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Zimbabwe Antiretroviral Therapy Program: Issues and Opportunities for Initiation and Expansion Zimbabwe Antiretroviral Therapy Program: Issues and Opportunities for Initiation and Expansion Ms. Marilyn Noguera Mr. David Alt Dr. Lisa Hirschhorn Dr. Chiedza Maponga Dr. Patrick Osewe Dr. Amos Sam-Abbenyi February 2003 Zimbabwe: Antiretroviral Therapy Program Issues and Opportunities for Initiation and Expansion Ms. Marilyn Noguera Mr. David Alt Dr. Lisa Hirschhorn Dr. Chiedza Maponga Dr. Patrick Osewe Dr. Amos Sam-Abbenyi February 2003 DELIVER DELIVER, a five-year, worldwide technical assistance support contract, is funded by the Commodity Security and Logistics Division (CSL) of the Office of Population and Reproductive Health of the Bureau for Global Health (GH) Field Support and Research of the U.S. Agency for International Development (USAID). Implemented by John Snow, Inc. (JSI) (contract no. HRN-C-00-00-00010-00), and subcontractors (Manoff Group, Program for Appropriate Technology in Health [PATH], Social Sectors Development Strategies, Inc., and Synaxis, Inc.), DELIVER strengthens the supply chains of health and family planning programs in developing countries to ensure the availability of critical health products for customers. DELIVER also provides technical support to USAID’s central contraceptive procurement and management and analysis of USAID’s central commodity management information system (NEWVERN). This document does not necessarily represent the views or opinions of USAID. It may be reproduced if credit is given to DELIVER/John Snow, Inc. Recommended Citation Noguera, Ms. Marilyn, Mr. David Alt, Dr. Lisa Hirschhorn, Dr. Chiedza Maponga, Dr. Patrick Osewe, and Dr. Amos Sam-Abbenyi. 2003. Zimbabwe: Antiretroviral Therapy Program—Issues and Opportunities for Initiation and Expansion. Arlington, Va.: DELIVER/John Snow, Inc., for the U.S. Agency for International Development. Abstract This report presents the findings of a four-week assessment of the readiness and capacity of Zimbabwe’s health sector to deliver the range of services and manage the health commodities required for effective antiretroviral (ART) treatment. HIV/AIDS prevention, diagnostic and treatment programs cannot succeed without a reliable and consistent supply of condoms, high-quality drugs, HIV test kits, laboratory reagents, and the consumable laboratory and medical supplies. The country’s public and private sector health providers have a great depth of experience and the team identified the service delivery and logistics experience, as well as lessons learned from the few providers already using ARV treatment, that will serve as a sound foundation for initiating and expanding ART. The report also specifies the critical logistics management and clinical issues that the government must address to ensure the safe and effective implementation of a national ART program. DELIVER John Snow, Inc. 1616 North Fort Myer Drive, 11th Floor Arlington, VA 22209 USA Phone: 703-528-7474 Fax: 703-528-7480 Email: [email protected] Internet: deliver.jsi.com Contents Acronyms ................................................................................................................................................v Acknowledgments................................................................................................................................. vii Executive Summary............................................................................................................................... ix Logistics Management ........................................................................................................................x Clinical Service Initiation and Expansion ........................................................................................... xi Background.............................................................................................................................................1 HIV/AIDS Prevalence and Impact .......................................................................................................1 Government and Donor Response......................................................................................................1 Government Plan for Nationwide ART Program .................................................................................1 Assessment Framework and Methodology.............................................................................................5 Purpose and Objectives ......................................................................................................................5 Assessment Framework......................................................................................................................5 Methodology........................................................................................................................................8 Assessment team ............................................................................................................................8 Tools ................................................................................................................................................8 “Stakeholder” interviews ..................................................................................................................9 Public health facilities selected......................................................................................................10 Limitations......................................................................................................................................10 Findings.................................................................................................................................................13 HIV/AIDS Related Services (Customer Service)...............................................................................13 HIV counseling and testing services..............................................................................................13 Prevention of mother-to-child transmission ...................................................................................13 Primary HIV care, TB, and OI treatment services .........................................................................14 Services available at sites visited ..................................................................................................15 Highly active antiretroviral therapy (HAART).................................................................................17 Personnel capacity ........................................................................................................................19 Laboratory capacity .......................................................................................................................19 Facility readiness to provide ART services....................................................................................21 Logistics Management ......................................................................................................................24 Forecasting ....................................................................................................................................24 Procurement ..................................................................................................................................25 Product quality assurance .............................................................................................................27 Inventory management, storage, and distribution .........................................................................28 Organizational capacity .................................................................................................................31 Logistics management information system ...................................................................................31 Funding sources for drugs and other requirements ......................................................................32 iii Zimbabwe: ART Program—Issues and Opportunities for Initiation and Expansion Conclusions and Recommendations.................................................................................................... 33 Logistics Management...................................................................................................................... 33 Clinical Service Initiation and Expansion.......................................................................................... 35 Secondary recommendations .......................................................................................................37 Appendix A: Facility Logistics Management Questionnaire ................................................................ 43 Appendix B: Facility Services And Infrastructure Questionnaire.......................................................... 59 Appendix C: Persons Contacted for ARV Assessment........................................................................ 87 Public Health Sector ......................................................................................................................... 87 Private Sector ................................................................................................................................... 89 National NGOs.................................................................................................................................. 90 Donors and Collaborating Agencies ................................................................................................. 90 Appendix D: List of ARVs Registered in
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