Stockouts of HIV commodities in public health facilities in Kinshasa: Barriers to end HIV

PLoS One. 2018 Jan 19;13(1):e0191294. doi: 10.1371/journal.pone.0191294. eCollection 2018.


Stockouts of HIV commodities increase the risk of treatment interruption, antiretroviral resistance, treatment failure, morbidity and mortality. The study objective was to assess the magnitude and duration of stockouts of HIV medicines and diagnostic tests in public facilities in Kinshasa, Democratic Republic of the Congo. This was a cross-sectional survey involving visits to facilities and warehouses in April and May 2015. All zonal warehouses, all public facilities with more than 200 patients on antiretroviral treatment (ART) (high-burden facilities) and a purposive sample of facilities with 200 or fewer patients (low-burden facilities) in Kinshasa were selected. We focused on three adult ART formulations, cotrimoxazole tablets, and HIV diagnostic tests. Availability of items was determined by physical check, while stockout duration until the day of the survey visit was verified with stock cards. In case of ART stockouts, we asked the pharmacist in charge what the facility coping strategy was for patients needing those medicines. The study included 28 high-burden facilities and 64 low-burden facilities, together serving around 22000 ART patients. During the study period, a national shortage of the newly introduced first-line regimen Tenofovir-Lamivudine-Efavirenz resulted in stockouts of this regimen in 56% of high-burden and 43% of low-burden facilities, lasting a median of 36 (interquartile range 29-90) and 44 days (interquartile range 24-90) until the day of the survey visit, respectively. Each of the other investigated commodities were found out of stock in at least two low-burden and two high-burden facilities. In 30/41 (73%) of stockout cases, the commodity was absent at the facility but present at the upstream warehouse. In 30/57 (54%) of ART stockout cases, patients did not receive any medicines. In some cases, patients were switched to different ART formulations or regimens. Stockouts of HIV commodities were common in the visited facilities. Introduction of new ART regimens needs additional planning.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Commodification*
  • Cross-Sectional Studies
  • Democratic Republic of the Congo
  • HIV Infections / therapy*
  • Health Facilities / economics*
  • Health Resources / economics*
  • Health Resources / supply & distribution*
  • Humans
  • Surveys and Questionnaires

Grants and funding

This research was conducted through the Structured Operational Research and Training Initiative (SORT IT), a global partnership led by the Special Programme for Research and Training in Tropical Diseases at the World Health Organization (WHO/TDR). The training model is based on a course developed jointly by the International Union Against Tuberculosis and Lung Disease (The Union) and Medécins sans Frontières (MSF). The specific SORT IT program which resulted in this publication was implemented by: Medécins Sans Frontières, Brussels Operational Center, Luxembourg and the Centre for Operational Research, The Union, Paris, France. Mentorship and the coordination/facilitation of these SORT IT workshops were provided through the Centre for Operational Research, The Union, Paris, France; the Operational Research Unit (LuxOR), AMPATH, Eldoret, Kenya; Institute of Tropical Medicine, Antwerp, Belgium; University of Gondar, Ethiopia; School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA; Luke International, Malawi office; The Centre for International Health, University of Bergen, Norway; and the Northern State Medical University, Arkhangelsh, Russia. The program was funded by the United Kingdom’s Department for International Development (DFID), The Union, MSF and La Fondation Veuve Emile Metz-Tesch (Luxembourg). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.