title: Availability of essential drugs for managing HIV-related pain and symptoms within 120 PEPFAR-funded health facilities in East Africa: a cross-sectional survey with onsite verification.
abstract: BACKGROUND
  World Health Organization's essential drugs list can control the highly prevalent HIV-related pain and symptoms. Availability of essential medicines directly influences clinicians' ability to effectively manage distressing manifestations of HIV.
  
  
  OBJECTIVE
  To determine the availability of pain and symptom controlling drugs in East Africa within President's Emergency Plan for AIDS Relief-funded HIV health care facilities.
  
  
  METHODS
  Directly observed quantitative health facilities' pharmacy stock review. We measured availability, expiration and stock-outs of specified drugs required for routine HIV management, including the World Health Organization pain ladder.
  
  
  METHODS
  A stratified random sample in 120 President's Emergency Plan for AIDS Relief-funded HIV care facilities (referral and district hospitals, health posts/centres and home-based care providers) in Kenya and Uganda.
  
  
  RESULTS
  Non-opioid analgesics (73%) and co-trimoxazole (64%) were the most commonly available drugs and morphine (7%) the least. Drug availability was higher in hospitals and lower in health centres, health posts and home-based care facilities. Facilities generally did not use minimum stock levels, and stock-outs were frequently reported. The most common drugs had each been out of stock in the past 6 months in 47% of facilities stocking them. When a minimum stock level was defined, probability of a stock-out in the previous 6 months was 32.6%, compared to 45.5% when there was no defined minimum stock level (χ (2) = 5.07, p = 0.024).
  
  
  CONCLUSIONS
  The data demonstrate poor essential drug availability, particularly analgesia, limited by facility type. The lack of strong opioids, isoniazid and paediatric formulations is concerning. Inadequate drug availability prevents implementation of simple clinical pain and symptom control protocols, causing unnecessary distress. Research is needed to identify supply chain mechanisms that lead to these problems.
authors.affiliation: 1Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Harding
authors.forename: Victoria
authors.initials: V
authors.lastname: Simms
authors.forename: Suzanne
authors.initials: S
authors.lastname: Penfold
authors.forename: Julia
authors.initials: J
authors.lastname: Downing
authors.forename: Richard A
authors.initials: RA
authors.lastname: Powell
authors.forename: Faith
authors.initials: F
authors.lastname: Mwangi-Powell
authors.forename: Eve
authors.initials: E
authors.lastname: Namisango
authors.forename: Scott
authors.initials: S
authors.lastname: Moreland
authors.forename: Nancy
authors.initials: N
authors.lastname: Gikaara
authors.forename: Mackuline
authors.initials: M
authors.lastname: Atieno
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kataike
authors.forename: Clare
authors.initials: C
authors.lastname: Nsubuga
authors.forename: Grace
authors.initials: G
authors.lastname: Munene
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Banga
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
mesh_terms: D003430:Cross-Sectional Studies; D018954:Drugs, Essential / Q000600:supply & distribution*; D005380:Financing, Government; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006268:Health Facilities / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000592:standards; D006302:Health Services Research; D006801:Humans; D007630:Kenya; D010146:Pain / Q000188:drug therapy*; D014454:Uganda
chemical_list: D018954:Drugs, Essential
keywords: East Africa; HIV; drug availability; health care surveys; pain; pharmacy; symptoms