Quantification and Supply Planning for Commodities Needed to Deliver the WHO-recommended Advanced HIV Disease Package of Care

Overview

Updated July 2023

To address the leading causes of morbidity and mortality caused by advanced HIV disease (AHD), the World Health Organization (WHO) recommends providing a package of interventions to all populations and age groups of people living with HIV (PLHIV) and presenting with AHD. The package of care includes screening for AHD through CD4 testing and/or WHO clinical staging; prevention, diagnosis, treatment, and/or prophylaxis for major opportunistic infections; rapid initiation of antiretroviral therapy (ART); and intensified treatment adherence support. Successful delivery of the AHD package of care requires stable access to a range of diagnostic and therapeutic products. However, many national programs struggle to quantify, procure, and deliver critical AHD commodities to the health care services and clients who need them.

With funding from various donors, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) continues to support comprehensive AHD programs in over 400 sites across nine countries: Cameroon, Côte d’Ivoire, Democratic Republic of Congo, Kenya, Lesotho, Malawi, Mozambique, Tanzania, and Zimbabwe. The aim is to strengthen AHD services for PLHIV, with a focus on improving access to and use of key AHD commodities. Through these efforts, significant challenges have been identified. For example, with funding from the CDC Foundation and the Bill and Melinda Gates Foundation, EGPAF identified challenges in quantifying and planning for AHD diagnostics and therapeutics as well as ancillary supplies, such as sample transport tubes. Challenges included a short shelf life for some diagnostic tests of 6 to 18 months after delivery in country; difficulty quantifying the need for new commodities due to limited demographic, epidemiologic, and/or historical consumption data; the ability to diagnose but not treat opportunistic infections due to shortages of some medicines; challenges in ensuring access for all AHD clients to low-volume products such as 5-flucytosine, liposomal Amphotericin B, and those that require highly-skilled administration, such as fluconazole, CrAg-LFA, due to frequent stock outs; and the need to coordinate quantification and procurement among several different donors and ministry of health (MOH) programs, such as HIV, TB, and immunization programs.