Managing Pharmaceuticals for TB/HIV Collaboration: Lessons Learned from a Five-Country Study in East Africa Management Sciences for Health is a nonprofit organization strengthening health programs worldwide. This report was made possible through support provided by the U.S. Agency for International Development, under the terms of Cooperative Agreement Number HRN-A-00-00-00016-00. The opinions expressed herein are those of the author(s) and do not Chinwe Owunna necessarily reflect the views of the U.S. Agency for International Development. Hella Witt July 2007 Managing Pharmaceuticals for TB/HIV Collaboration: Lessons Learned from a Five-Country Study in East Africa Chinwe Owunna Hella Witt Printed July 2007 Rational Pharmaceutical Management Plus Center for Pharmaceutical Management Management Sciences for Health 4301 N. Fairfax Drive, Suite 400 Arlington, VA 22203 USA Phone: 703-524-6575 Fax: 703-524-7898 E-mail: [email protected] SO5 TB Managing Pharmaceuticals for TB/HIV Collaboration: Lessons Learned from a Five-Country Study in East Africa This report was made possible through support provided by the U.S. Agency for International Development, under the terms of cooperative agreement number HRN-A-00-00-00016-00. The opinions expressed herein are those of the author(s) and do not necessarily reflect the views of the U.S. Agency for International Development. About RPM Plus RPM Plus works in more than 20 developing and transitional countries to provide technical assistance to strengthen pharmaceutical and health commodity management systems. The program offers technical guidance and assists in strategy development and program implementation both in improving the availability of health commodities—pharmaceuticals, vaccines, supplies, and basic medical equipment—of assured quality for maternal and child health, HIV/AIDS, infectious diseases, and family planning and in promoting the appropriate use of health commodities in the public and private sectors. Recommended Citation This report may be reproduced if credit is given to RPM Plus. Please use the following citation. Owunna, C. and H. Witt. 2007. Managing Pharmaceuticals for TB/HIV Collaboration: Lessons Learned from a Five-Country Study in East Africa. Submitted to the U.S. Agency for International Development by the Rational Pharmaceutical Management Plus Program. Arlington, VA: Management Sciences for Health. Key Words TB/HIV, Malawi, Ethiopia, Kenya, Tanzania, Uganda, assessment, pharmaceuticals Rational Pharmaceutical Management Plus Center for Pharmaceutical Management Management Sciences for Health 4301 North Fairfax Drive, Suite 400 Arlington, VA 22203 USA Telephone: 703-524-6575 Fax: 703-524-7898 E-mail: [email protected] Web: www.msh.org/rpmplus.org ii CONTENTS ACRONYMS.................................................................................................................................. v ACKNOWLEDGMENT............................................................................................................... vii BACKGROUND ............................................................................................................................ 1 PLANNING FOR TB/HIV COLLABORATION.......................................................................... 3 STUDY PURPOSE......................................................................................................................... 7 STUDY METHODOLOGY ........................................................................................................... 9 STUDY RESULTS AND LESSONS LEARNED ....................................................................... 11 National-Level Coordination Supporting TB/HIV Collaboration ............................................ 11 Implementation of TB/HIV Collaborative Activities ............................................................... 13 Managing TB/HIV Pharmaceuticals......................................................................................... 15 Managing Information for Monitoring and Evaluation ............................................................ 17 Supervising TB/HIV Collaborative Activities.......................................................................... 19 HIV Testing in TB Patients....................................................................................................... 20 Pharmaceutical Management in Isoniazid Preventive Therapy................................................ 21 Pharmaceutical Management in Co-trimoxazole Preventive Therapy ..................................... 23 Monitoring and Promoting Treatment Adherence.................................................................... 27 CONCLUSIONS........................................................................................................................... 29 ANNEX 1. MANAGING PHARMACEUTICALS FOR TB/HIV COLLABORATION IN ETHIOPIA: RESULTS FROM A TWO-PHASE ASSESSMENT.............................................. 35 Background............................................................................................................................... 35 Study Methodology................................................................................................................... 36 Assessment Results................................................................................................................... 38 Lessons Learned........................................................................................................................ 49 Conclusions............................................................................................................................... 51 Appendix A. Summary of Services in Assessment Facilities................................................... 54 Appendix B. Documents Reviewed.......................................................................................... 55 Appendix C. Data Collector and Key Stakeholders Interviewed ............................................. 57 ANNEX 2. MANAGING PHARMACEUTICALS FOR TB/HIV IN COLLABORATION IN KENYA: ASSESSMENT RESULTS........................................................................................... 61 Background............................................................................................................................... 61 Study Methodology................................................................................................................... 62 Assessment Results................................................................................................................... 63 Lessons Learned........................................................................................................................ 68 Conclusions............................................................................................................................... 69 Appendix A. Data Collectors and Key Stakeholders Interviewed............................................ 71 iii Managing Pharmaceuticals for TB/HIV Collaboration: Lessons Learned from a Five-Country Study in East Africa ANNEX 3. MANAGING PHARMACEUTICALS FOR TB/HIV COLLABORATION IN MALAWI: RESULTS FROM A TWO-PHASED ASSESSMENT ............................................ 73 Background............................................................................................................................... 73 Study Methodology................................................................................................................... 74 Assessment Results................................................................................................................... 75 Lessons Learned........................................................................................................................ 85 Conclusions............................................................................................................................... 87 Appendix A. Data Collectors and Key Stakeholders Interviewed............................................ 90 ANNEX 4. MANAGING PHARMACEUTICALS FOR TB/HIV COLLABORATION IN TANZANIA: ASSESSMENT RESULTS.................................................................................... 91 Background............................................................................................................................... 91 Purpose of the Study ................................................................................................................. 92 Study Methodology................................................................................................................... 93 Assessment Results................................................................................................................... 94 Lessons Learned...................................................................................................................... 100 Conclusions............................................................................................................................. 102 Appendix A. Documents Reviewed........................................................................................ 104 Appendix B. Data Collectors and Key Stakeholders Interviewed.......................................... 105 ANNEX 5. MANAGING PHARMACEUTICALS FOR TB/HIV COLLABORATION IN UGANDA: ASSESSMENT RESULTS ..................................................................................... 107 Background............................................................................................................................