9.7 Procurement and supply management systems
Consolidated ARV guidelines, June 2013
188.8.131.52 Selecting pharmaceuticals and diagnostics
Countries adapting these guidelines may need to update national medicine lists to include newly recommended ARV drug regimens and formulations and diagnostics. The advantage of using the essential list concept is to enable a health system to limit other more expensive or WHO-delisted medicines and diagnostics from being purchased and accelerating the registration of WHO-prequalified products to facilitate quality-assured procurement (123). If a selected fixed-dose combination or other ARV drug regimen is not on the national list or not registered in the country, HIV programme managers need to coordinate with the national drug regulatory authority and request that these drugs be put on the list and registered.
Detailed national ART guidelines, for example, that provide recommendations for managing toxicity or treatment failure and recommended formulations for weight and age can help to standardize prescribing and dispensing practices and facilitate forecasting for ARV drugs.
Synchronized introduction of new guidelines with forecasting, procurement and distribution planning during the phasing in and phasing out of new and old ARV drug products will minimize the waste of products that are being phased out and shortages of newly recommended products.
In several settings, paediatric formulations are not widely available. The national medicine list should be optimized for paediatric ARV drug formulations, to include fixeddose combinations, scored or dispersible products that facilitate adherence and supply management. Countries may consider removing less preferred products and aligning paediatric formulations with those of adults, where possible.
Health workers need to be trained at different levels in managing pharmaceuticals and diagnostics, including forecasting, procurement and distribution and ensuring adequate supervision throughout the supply system.