HIV commodity supply cycle

Clinical description

• Table 28 shows the different commodity groups currently managed by the HIV Program.

Table 28: Drugs and supplies managed by the HIV Program Commodity group Examples Supply* ARVs (All ARVs, incl. PEP, PrEP and infant prophylaxis) E OI prophylaxis Cotrimoxazole for CPT E TPT Isoniazid, Rifapentine + pyridoxine for TPT E OI treatment Cotrimoxazole, other antibiotics, fluconazole, chemotherapy S STI Standard/alternative antibiotics, acyclovir, clotrimazole S Cervical cancer Cervical cancer screening tools S VMMC Shang rings and conventional circumcision kits E PIFP Condoms S AHD Serum CrAG, PIMA beads S Analgesic Morphine, codeine S DBS, plasma kits For EID and VL samples E Rapid tests HIV, viral hepatitis and syphilis rapid test kits E Supply*: E = item managed exclusively through HIV Program.

S = items supplemented by HIV Program in addition to essential medicine supplies.

• HIV commodities are delivered every 2 months from a central warehouse (Lilongwe) directly to all

facilities.

• Distribution lists for all facilities are calculated based on the patient and stock reports collected

during quarterly HIV Program supervision and reported through the Logistics Management Information System.

• Actively support the 2-monthly supply cycle and the ongoing management following the 11 steps

in Figure 7 below.

128 HIV commodity supply cycle Figure 7: Flowchart for HIV commodity supply management HIV commodity supply cycle

• Prepare stock/patient report (Pharmacy/drug store-in-charge & clinician)
• Confirm each commodity is sorted by expiry date.
• Do physical count of stock on hand (SOH). Exclude any units that are damaged or already expired.
• Ensure all available stock is counted, including in bulk store, at the clinic/HIV testing rooms, etc.
• Verify data (HIV program supervision & team)
• Ensure all storage areas and patient records/registers are accessible on the day of supervision.
• The HIV Program supervision team will work with facility staff to verify:

o Stock reports by doing a physical count.

o Verify completeness of stock cards, relocation books, delivery notes/goods received notes and requisition and issue vouchers (RIVs).

o Patient data by reviewing patient cards and registers.

• Check that the stock report filled during supervision is complete and accurate. The supervision

team and the pharmacy in-charge are responsible for confirming this by signing the form.

• Review of draft distribution list (HIV logistics and M & E teams)
• 2-monthly consignments are calculated by HIV Logistics from patient numbers and stock reports

collected at the last supervision visit.

o All HIV related commodities should be about 2 MOS (months of stock, see below).

o Consignments are scheduled to arrive every 2 months.

o Facilities should have about 2 MOS remaining when the new consignment arrives bringing the total available stock to about 4 MOS.

• HIV Logistics will circulate the draft distribution list to anyone registered with their email address.

To register, send an email request to hivdeptsupplychain@hivmw.org. Anyone can also subscribe for an automatic notification by email and/or SMS whenever a distribution list is posted for review on the HIV Dept. website (www.hiv.health.gov.mw).

• Review and confirm: the items and quantities are correct and adequate for you. Submit any

suggested changes (by email, SMS or phone) with justification before the deadline shown on the draft list.

• Receive consignment (Pharmacy-in-charge)
• Inspect the entire consignment in the presence of a witness designated by DHMT/facility In-charge:

o Physically count all re-packed/loose units. Originally sealed boxes do not need to be opened for counting of units. Add up total units received for each item.

o Check batch number and expiry date for all items.

o Write physical count for each item into the respective box on the delivery note. Write 0 (zero) for any items not received – don’t leave any boxes empty.

• Sign, date and stamp the delivery note to confirm receipt of the items as indicated.
• The person signing on the delivery note is accountable for all items s/he has signed for. The

facility/Pharmacy In-Charge will be held responsible for any discrepancies noted later.

• Store (Pharmacy-in-charge)
• Immediately move all items received to a secure storage area (clean, dry, cool and off the floor).

130 HIV commodity supply cycle

• Enter quantity and date of receipts on stock cards without delay.
• Arrange items by expiry date to make it easy to follow the First Expiry -First Out principle (FEFO).
• Issue to clinic (Pharmacy-in-charge)
• The user units/departments will request for commodities from the store using Requisition and

Issue Vouchers.

• Ensure that the facility in-charge or assigned designated approves the request for commodities
• The Pharmacy/stores in-charge assess the stocks and issues accordingly.
• Always follow the FEFO principle.
• Immediately update stock card when moving items out of the pharmacy.
• Limit the amount of stock stored at the clinic to 1-week consumption.
• Dispense/use (Clinician)
• Ensure that the patient has fully understood:

o How and when to take their drugs.

o Possible side-effects; which side-effects require coming to the health facility.

o Using the adverse drug reaction form (ADR) ensure that all ADR related issues are documented and reported to HIV Dept. and PMRA

• Account for all HIV commodities dispensed. Specify type and quantity:

o On patient master cards (ART, Exposed child).

o Dispensing registers for ARVs, OIs/STI and special drugs.

o Daily Activity Registers (DAR) for HIV test kits.

• The DAR is used for tracking use of test kits.

o Keep a separate register at all places where testing is done.

o Use separate registers for the different types of tests (Determine, Uni-Gold, and other test kits).

o Test kits used for clients must match entries in the HIV testing Register.

o The DAR includes sets of 3 carbonated sheets: keep white sheet at facility; send blue sheet to DHO; retain pink/yellow sheet for collection by HIV Logistics (MOH).

o Fill monthly summary on HIV testing report by adding numbers from all DAR used at the facility.

• Monitor stocks/consumption (Pharmacy-in-charge)
• Do a physical stock count for all items (in store and at the clinic) and update stock cards:

o On the last working day of each month.

o When handing over pharmacy management to another staff member.

o Whenever discrepancies are noted or any other special scenarios such as clinic closure, fire, theft etc.

HIV commodity supply cycle

• Calculate average monthly consumption (AMC) and months of stock (MOS) for all ARVs and HIV

test kits after doing the monthly physical count:

• Be alert: commodity shortages can be anticipated before they happen:

o Large number of transfers in.

o Patients transition to alternative regimens or switching to 2nd line or 3rd line regimens.

o Rapid scale up through new initiations.

• As soon as commodity shortage is suspected or noticed:

o Contact HIV Logistics for additional supply (see below).

o Inform all relevant staff members.

o Prioritize use (e.g., HIV test kits for sick patients needing to start ART, women at ANC and maternity, etc.).

o Shorten supply interval (e.g., give ARVs for 1 month instead of 3 or 6).

• Commodity excess: more than 4 MOS, especially if units will expire before they can be used:
• Contact HIV Logistics for to request stock relocation (see below).
• Request adjustment (Pharmacy-in-charge & HIV logistics)
• Call HIV Logistics as soon as possible if shortage, excess or expiry is noted.
• Before calling, prepare the following information:

o Number of tins / bottles / tests remaining.

o Expiry date o Number of patients on this regimen / approximate AMC.

o When additional stocks are needed / to be sent to another site.

o If own transport can be organized.

• HIV Logistics will:

o Review the information and find out the reason for the problem.

o Coordinate: extra allocation from the warehouse, relocation of stocks between sites, or register disposal of expired commodities.

o Send a unique Authorization Code for each item by SMS or phone.

• Confirm receipt of authorization codes by sending ‘OK’ by SMS or by calling HIV Logistics.
• Fill a Registration Form for Relocation or Disposal of HIV Commodities for each adjustment.

o Write the authorization code for each item on the form.

o File the Registration Forms in the pharmacy to account for all commodity transactions.

• Caution: Never relocate or dispose HIV commodities without authorization code. In exceptional

circumstances (threating stock-out and no phone coverage / no answer), stocks may be relocated, and notification and authorization codes must be obtained at the earliest opportunity.

132 HIV commodity supply cycle

• Collect/receive/release stock from adjustment (Pharmacy-in-charge)
• When collecting extra consignments from the warehouse:

o Ask for the size of the consignment and make sure it can be safely transported (security, sun/rain protection, etc). Partial collection will not be allowed.

o Make specific appointment and get directions from HIV Logistics.

o Bring ID (passport, driving license, etc) and official facility stamp.

o Inspect the whole consignment.

o The collecting officer and a witness must fill, sign and stamp the delivery note as usual.

o There is no need to fill a Registration Form for Relocation for extra allocations from the warehouse.

• Relocating stocks between facilities:

o Fill a Registration Form for Relocation and write the authorization code for each item.

o Keep the white copy of the form at the facility releasing the stock. This is mandatory to account for commodities given away to another site.

o Give the blue copy of the form to the facility receiving the relocated commodities.

o Retain the pink copy of the form for collection by Ministry of health-HIV logistics.

o The receiving facility must enter the commodities on the stock cards in the pharmacy and issue as per the issuing procedure (as above 6).

• Disposal (Pharmacy-in-charge)
• Update the stock card by subtracting off the expired quantity.
• Separate expired commodities from usable stock.
• Notify HIV logistics, get Authorization code and fill the registration form for relocation and disposal.
• Update the Health facility expired commodity list.
• Contact the District Pharmacist and arrange for transfer of expired items for controlled destruction.

Appendix