title: Ensuring uninterrupted supplies of antiretroviral drugs in resource-poor settings: an example from Malawi.
abstract: OBJECTIVE
  Drug procurement and distribution practices are weak in many resource-poor countries, and are a major reason for lack of access to medicines. With many countries scaling up antiretroviral therapy (ART), it is vital to avoid interrupted drug supplies, which would lead to drug resistance and treatment failure.
  
  
  METHODS
  Malawi has adapted a model, based on that adopted by the country's Tuberculosis Control Programme, to allow rational ART drug forecasting.
  
  
  METHODS
  The model includes a focus on one standardized first-line ART regimen; a "push system" and "ceilings" for first-line ART drugs for facilities; use of starter pack and continuation pack kits; quarterly monitoring of patient outcomes and ART drug stocks at facility level; provision of a three-month buffer stock of ART drugs at facility level; and use of a procurement and distribution system outside central medical stores.
  
  
  CONCLUSIONS
  The focus on a single first-line regimen, "ceilings" for first-line ART drugs and quarterly data collections to calculate drug needs (for new and follow-up patients, respectively), as well as the use of an independent procurement facility, allow drug orders to be made 6-9 months ahead. These measures have so far ensured that there have been no ART drug stock-outs in the country.
authors.affiliation: Clinical HIV Unit, Ministry of Health, Lilongwe, Malawi. adharries@malawi.net
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harries
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Schouten
authors.forename: Simon D
authors.initials: SD
authors.lastname: Makombe
authors.forename: Edwin
authors.initials: E
authors.lastname: Libamba
authors.forename: Henry N
authors.initials: HN
authors.lastname: Neufville
authors.forename: Eliab
authors.initials: E
authors.lastname: Some
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kadewere
authors.forename: Douglas
authors.initials: D
authors.lastname: Lungu
mesh_terms: D044966:Anti-Retroviral Agents / Q000191:economics / Q000600:supply & distribution*; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006801:Humans; D008295:Malawi; D011203:Poverty; D040841:Resource Allocation / Q000191:economics / Q000458:organization & administration*; D012935:Social Justice; D012959:Socioeconomic Factors
chemical_list: D044966:Anti-Retroviral Agents