Table 2 Key characteristics of ‘kit system’ and ‘standard path delivery’ for the supply of CTZ

Meaning

Kit: Box with pre-defined number of essential medicines and medical supply (altogether nearly 60 items)

Health facility specific requisition of any medicine/ medical supply included on the list of publicly funded medicines

Combination supply chain strategy

Basic stock via push system:

Automated delivery of prepacked kits that include CTZ based on each facility's number of outpatient consultations

Top up of stock via pull system:

Additional delivery of CTZ as per requisition (if the demand exceeds the quantities available at the health facility level)

Stakeholder(s) responsible for quantification

Technical group for quantification at the central level (comprised of CMAM, HIV Program, Data manager), and representatives of principal partners (i.e. Global Fund, PEPFAR, MSF)

Health facility pharmacy personnel

Quantification [method]

[Morbidity method]

• Procurement: Calculating the theoretical quantity of CTZ for one year (in advance) considering:

 - CTZ as preventive treatment for PLHIV

 - CTZ as antibiotic treatment of bacterial infections among the general population

• Automated delivery: supplying quantity of kits per health facility based on monthly mean number of outpatient consultations

[Consumption method]

• Health facility-based requisition: electronic generation and submission of a monthly report (that includes all data needed for quantification) via one of two logistics information systems: SIMAM (central level platform used at high patient turnover facilities) or SIGLUS (newer platform used at lower patient turnover facilities)

• Calculating the quantity of additional CTZ needed for the ongoing month, considering:

 - Total quantity of CTZ needed for the month (likely consumption based on the previous month's number of outpatient consultations registered through SESP (electronic information system for patient follow-up))

 - Subtracting existing quantity of CTZ available at the health facility (stock inventory)

 - Multiplying by 2: to include security (buffer) stock

Planning

1. Selecting list of essential medicines and medical supply items for kits

2. Determining quantities for each item per one kit, which is designed for 1000 outpatient consultations

3. Inviting tenders to provide offers for kit supply contracts

4. Contracting tenders, based on best price and quality of test kit content and packaging

1. Inviting local pharmaceutical companies to provide their best price for large quantities of CTZ

2. Contracting local company to produce and deliver CTZ to central level warehouses on a monthly basis

Pharmaceutical procurement

Purchasing pre-packed kits from overseas

Purchasing of CTZ from local pharmaceutical company (STRIDES; April 2019)

Supply chain

Delivery to health facility

Beginning of each month

Middle of each month (5th to 15th day of a month)