Background The first pillar of the UNAIDS ۹۰-۹۰-۹۰ goal seeks to accurately identify persons living with
HIV (PLHIV), a process that is predicated on facilities having the necessary
HIV tests available to perform the task. In many rural settings, the identification of PLHIV is accomplished through a two-step process involving the sequential use of ۲ separate rapid diagnostic tests (RDTs). Inadequate inventory of either test has ramifications for the success of HIV-related programs. The purpose of this study was to evaluate the inventory levels of
HIV RDT kits at specific healthcare facilities in Zambézia province, Mozambique. Methods Using facility-level pharmacy stock surveillance data from October ۲۰۱۵ through September ۲۰۱۶, we assessed the inventory levels of
HIV RDTs at ۷۵ health facilities in ۸ districts within Zambézia province, Mozambique. Using programmatically established categories (good, sufficient, threatened, or stockout), defined in conjunction with the provincial health authorities, descriptive statistics were performed to determine inventory control of
HIV RDTs at the district and health facility levels. Monthly proportions of adequate (good + sufficient) inventory were calculated for each district to identify inventory trends over the evaluation period. To assess whether the proportion of inadequate stocks differed between RDT, a mixed-effects logistic regression was conducted, with inadequate inventory status as the outcome of interest. Results When viewed as a whole, the inventory of each test kit was reported as being at adequate levels more than ۸۹% of the time across the ۷۵ facilities. However, disaggregated analysis revealed significant variability in the inventory levels of
HIV RDTs at the district level. Specifically, the districts of Inhassunge, Namacurra, and Pebane reported inadequate inventory levels (threatened + stockout), of one or both test kits, for more than ۱۰% of the study period. In addition, a disparity between inventory levels of each test kit was identified, with the odds of reporting inadequate inventory levels of the confirmatory test (Uni-Gold™) being approximately ۱.۸-fold greater than the initial test (Determine™) (odds ratio: ۱.۸۲, ۹۵% CI: ۱.۴۰-۲.۳۸). Conclusion As Test and Treat programs evolve, a significant emphasis should be placed on the “test” component of the strategy, beginning with assurances that health facilities have the adequate inventory of RDT necessary to meet the needs of their community. As national policy-makers rely predominantly on data from the upstream arm of the supply chain, it is unlikely the disparity between inventory levels of
HIV RDTs identified at individual districts and specific health facilities would have been recognized. Moving forward, our findings point to a need for (۱) renewed efforts reinforcing appropriate downstream forecasting of essential medicines and diagnostic tests in general and for Uni-Gold™ test kits specifically, and (۲) simple metrics that may be routinely collected at all health facilities and which may then easily and quickly flow upstream so that policy-makers may optimally allocate resources.
