Summary of the Report as of 1st February 2017

Transcription

1 MINISTRY OF HEALTH PHARMACY DIVISION Stock Status Report 1st February 2017 A Publication of The Ministry of Health Uganda The purpose of this report is to inform the Ministry of Health and all stakeholders of the stock levels in the country as a tool that enable appropriate logistics decisions making. This report highlights stock status, real challenges, bottlenecks but also recommends potential solutions to mitigate stock outs and expiries of ARVs & HIV test kits, ACTs, Anti-TB medicines, Reproductive Health items, selected Laboratory commodities, Vaccines and selected medicines for treatment of Opportunistic Infections In the Republic of Uganda This report serves to: - Act as an early warning indicator for potential stock outs and possible expiries of EMHS - Identify challenges and recommendations to avert supply interruptions - Encourage preparation and sharing of joint supply plans with stakeholders - Identify strategies for regularly reviewing supply plans for all the commodities - Encourage donors to honor their commitments in terms of quantities of products expected, timeliness of deliveries and flexibility. Summary of the Report as of 1st February 2017 This stock status report has been developed taking into account warehouse stock levels as of 1st February 2017 and stock updates received through February and March Warehouse data utilized includes information from NMS, JMS, MAUL, UHMG and Stock levels for third line ARVs at JCRC. Details on selected commodities at the central warehouse level and at facility level is given. Facility level analysis has been done using WAOS data for ARVs, MDR-TB facilities data plus DHIS2 data for TB commodities and ICCM stock level updates from the ICCM program. Antiretroviral Medicines The public sector(nms) is generally fairly stocked however, There are stock outs for Abacavir/lamivudine 600/300mg, Nevirapine 50mg, Kaletra syrup and Abacavir 60mg. The stock levels of these and other commodities are expected to improve with the signing of implementation letter with which public sector stock at JMS will be transferred to NMS enabling facility level distribution and with the receipt of the Global Fund pipeline under the costed extension. Additional funds for the procurement of ARV medicines have been obtained from PEPFAR(approx. 11.5M) and approx. 6.6M from the Global Fund savings in the TB grant and HIV grant. MAUL is well stocked for all commodities. JMS has low stock levels for over 70% of it's commodities. These low stock levels are majorly attributed to shipment delays for orders previously expected in December 2016 and early Interwarehouse transfers are still ongoing as a short term strategy to ensure availability of stock at JMS from NMS and MAUL. Orders for JMS are currently scheduled for arrival starting end of March 2017 to May 2017 for the different commodities. Third line ARVs at JCRC are well stocked except for Ritonavir 100mg that is stocked out. All other formulations are at a risk of stock out by June Orders for these commodities were placed with the supplier, however delivery dates are pending confirmation.

2 Antimalarial commodities The public sector generally has very low stock levels for all Artemether/Lumefantrine formulations with a stock out for Artesunate injection. Government of Uganda has provided additional funding for the procurement of antimalarials and additional funding will be obtained from GF-PR2 grant. Artemether/Lumefantrine formulations at JMS are well stocked. There are however low stock levels for Artesunate injection and Malaria RDTs. Efforts to obtain an emergency order of artesunate injection are ongoing. Facility level analysis needs to be done to establish the stock levels of artesunate injection and determine the possibility of redistribution of stock. Laboratory commodities Generally, HIV test kits are well stocked across warehouses except for the risk of stock out of Determine at NMS. Orders for SD Bio line have been placed for the public sector through the Global Fund and delivery dates are yet to be confirmed. JMS will continue to obtain StatPak from NMS to ensure utilization of available incountry stock. Viral load and EID reagents are at a risk of stock out. Orders have been placed with GHSC. Pima Cartridges and Blood collection tubes are at a risk of stock out at both JMS and NMS. FM and ZN reagents received for the TB diagnosis, lacks the acid alcohols required for use. Funding needs to be obtained to procure these commodities and thus facilitate TB diagnosis. Medicines for opportunistic infections MAUL is well stocked for all the cotrimoxazole and fluconazole formulations however, NMS and JMS have very low stock levels for both Cotrimoxazole and Fluconazole. Fluconazole shipments for JMS are expected in May 2017, however delivery dates for cotrimoxazole are pending confirmation. Interwarehouse transfer to JMS has been initiated for Cotrimoxazole 120mg from MAUL to avert the current stock out. Fluconazole orders through the diflucan partnership is being processed for the public sector. Vaccines Most of the vaccines are well stocked except for BCG and Inactivated Polio vaccine that are stocked out due to shipment delays. Stock levels are expected to return to the required level once shipments are received. Hepatitis B vaccines is well stocked at central level, however overstocks have been reported at facility level. Reproductive Health commodities Most reproductive health commodities are stocked out at NMS except for Depo-Provera, implanon and Misoprostol. Although Maternity Kits are available at the warehouse, low stock levels are maintained and call-off made just in-time for distribution due to the volume of these commodities. UHMG is well stocked except for Depo-Provera, Implanon and Jadelle. Condom lubricants procured through the Global Fund are available at UHMG. TB Commodities First line TB commodities are well stocked except for Isoniazid 100mg, Isoniazid 300mg and RHE 150/75/275mg that are stocked out. Stock out for these commodities may persist till shipments are received starting April MDR-TB medicines are well stocked except for moxifloxacin 500mg that is currently stocked out. Levofloxacin shipment that was previously delayed was received improving the stock levels for this commodity. A detailed account of each of the selected commodities is given below.

3 A : National Medical Stores Product Name measure Antiretroviral Medicines Adult first line formulations Efavirenz/Lamivudine/Tenofovir 600/300/300mg 1*30 tabs 786, , Lamivudine/Zidovudine/Nevirapine 150/300/200mg 1*60 tabs 1,094, , Lamivudine/Zidovudine 150/300mg 1*60 tabs 281,669 45, Tenofovir DF/Lamivudine 300/300mg 1*30 tabs 511, , Nevirapine 200mg 1*60 Tabs 262,358 36, Efavirenz 600mg 1*30 tabs 674, , Adult second line formulations Abacavir/Lamivudine, Scored, 600/300mg 1*30 tabs - 7, Atazanavir/Ritonavir 300/100mg 1*30 tabs 63,333 9, Lopinavir/Ritonavir 200/50mg 1*120 tabs 27,281 9, Pediatric first line formulations Abacavir/Lamivudine, Scored, 60/30mg 1*60 tabs 180,463 31, Abacavir/Lamivudine, Scored, 120/60mg 1*30 tabs - 31, Lamivudine/Zidovudine/Nevirapine 30/60/50mg 1*60 tabs 278,549 40, Lamivudine/Zidovudine 30/60mg 1*60 tabs 91,609 10, Nevirapine 10mg/ml 100 ml 1 bottle 36,311 5, Nevirapine 50mg 1*30 tabs 2,456 19, Efavirenz 200mg 1*90 tabs 19,839 10,

4 National Medical Stores Product Name measure Pediatric Second line formulations Abacavir 60mg dispersible 1*60 tabs Lopinavir/Ritonavir 100/25mg 1*60 tabs 9,387 5, Lopinavir/Ritonavir 40/10mg (oral pellets) 1*120 caps - 1, Lopinavir/Ritonavir 80/20mg/ml [KALETRA] 60ml 1*5 bottles Notes: ARV Commodities for the Public sector All adult First line formulations are well stocked except for Tenofovir/lamivudine300/300mg with less than 3 MOS. The stock levels of this commodity have been affected by the previous stock out of TDF/3TC/EFV 300/300/600mg that resulted into increased consumotion of Tenofovir/Lamivudine 300/300mg. Under the adult second line formulations, there stock out of Abacavir/lamivudine 600/300mg persists at the warehouse. This commoity is available uner the PEPFAR stock at JMS. Similarly low stock levels for Lopinavir/ritonavir 200/50 mg will be alleviated with the transfer of PEPFAR stock to NMS. Pediatric formulations All pediatric first line formulations are available in country for the public sector. There is a stock out of Nevirapine 50mg pending transfer of PEPFAR stock to NMS and low stock levels for EFV 200mg Abacavir/ Lamivudine 120/60mg is scheduled to arrive by the end of March The use of this formulation will commence once the incountry stock of Abacavir/lamivudine 60/30 mg is depleted. Pediatric second formulations are poorly stocked with stock outs for ABC 60mg and Kaletra syrup. Public sector facilities were availed with Kaletra syrup from MAUL. Kaletra pellets replacing the syrup was previously expected in Jan 2017 however, the shipment was delayed. Training on the use of the pellets is ongoing and a strategy is being developed to ensure treatment interruption is avoided. Funding for Public sector ARV Medicines From the PEPFAR 8.6M grant, Tenofovir/Lamivudine/Efavirenz 300/300/600mg has been transferred to NMS with the signing of implementation letter. The transfer of other commodities is still pending. Additional funding of approximately 11.5 Million USD has been received from PEPFAR. Orders under the additional fund are being processed for placement with the supplier. Under the current Global Fund grant; approximately 2.6 million USD and 4.04 million USD savings have been realized from the TB grant and HIV grant respectively. Funds from the TB grant will be used under the TB/HIV collaborative activities section. The supply plan for this additional funding realized has been finalized for orders to be placed with the supplier. With this additional funding received, the risk of stock out is reduced greatly however a funding gap still exists. The Global Fund concept note writing has been finalized, the fund will be available starting January Receipt of commodities is planned starting March It should be noted that central level warehouse transfer from NMS to JMS are ongoing to alleviate the low stock levels experienced currently at JMS.

5 B : Joint Medical Stores Product Name measure Adult first line formulations Efavirenz/Lamivudine/Tenofovir 600/300/300mg 1*30 tabs 73,533 38, Lamivudine/Zidovudine/Nevirapine 150/300/200mg 1*60 tabs 100,652 20, Lamivudine/Zidovudine 150/300mg 1*60 tabs 20,491 7, Tenofovir DF/Lamivudine 300/300mg 1*30 tabs 64,768 18, Nevirapine 200mg 1*60 Tabs 79,242 6, Efavirenz 600mg 1*30 tabs 52,196 16, Adult second line formulations Abacavir/Lamivudine, Scored, 600/300mg 1*30 tabs 178 1, Atazanavir/Ritonavir 300/100mg 1*30 tabs 5,166 1, Lopinavir/Ritonavir 200/50mg 1*120 tabs 33,479 3, Pediatric first line formulations Efavirenz 200mg 1*90 tabs 5, Abacavir/Lamivudine, Scored, 60/30mg 1*60 tabs 1,478 1, Abacavir/Lamivudine, Scored, 120/60mg 1*30 tabs - 1, Lamivudine/Zidovudine/Nevirapine 30/60/50mg 1*60 tabs 15,382 3, Lamivudine/Zidovudine 30/60mg 1*60 tabs 2, Nevirapine 10mg/ml 100 ml 1 bottle 1, Nevirapine 50mg 1*30 tabs 2,564 1,

6 Joint Medical Stores Product Name measure Pediatric second line formulations Lopinavir/Ritonavir 100/25mg 1*60 tabs 1, Lopinavir/Ritonavir 40/10mg (oral pellets) 1*120 caps Lopinavir/Ritonavir 80/20mg/ml [KALETRA] 60ml 1*5 bottles Min - 3; Max 6 ARV commodities at JMS Approximately 76% of all ARV formulations are below the minimum 3 MOS. The low stock levels are majorly attributed to shipment delays for orders previously expected by the end of 2016 and early Interwarehouse transfers between JMS and NMS are ongoing to ensure continuity in treatment for commodities that are adequately available at NMS. Commodities transferred from NMS to JMS in January 2017 include; Tenofovir/Lamivudine/Efavirenz 300/300/600mg(57,250 packs), Nevirapine syrup(1,350 bottles), lamivudine/zidovudine 30/60mg(2,500 packs), Abacavir/lamivudine 60/30mg (1,600 packs), and Lamivudine/zidovudine/Nevirapine 30/60/50mg (10,815 packs). Commodities under the current planned transfer include: Atazanavir/ritonavir 300/100mg( 9,500packs), Tenofovir/Lamivudine 300/300mg(42,000 packs), Tenofovir/Lamivudine/Efavirenz 300/300/600mg (120,000 packs), Efavirenz 600mg(33,400 packs), Lamivudine/Zidovudine 150/300mg (21,000 packs), Lamivudine/Zidovudine 30/60mg (1,800 packs). The current transfer is expected to be finalized by the end of March Transfer of Kaletra syrup from MAUL is pending concurrence from CDC. Kaletra syrup will be utilized by the patients 0-3years as we await the arrival of the Kaletra pellets in May With the supplier's expected delivery dates of April and May 2017 for most commodities efforts are ongoing to avoid stock outs at JMS and in the PNFP sector served by the warehouse. Shipment monitoring is ongoing to ensure a stable ARV medicines supply chain by June 2017 and for the rest of the year.

7 C : Medical Access Uganda Limited Product Name measure Adult first line formulations Efavirenz/Lamivudine/TDF 600/300/300mg 1*30 tabs 855, , Lamivudine/Zidovudine/Nevirapine 150/300/200mg 1*60 tabs 262,908 52, Lamivudine/Zidovudine 150/300mg 1*60 tabs 94,416 23, Tenofovir DF/Lamivudine 300/300mg 1*30 tabs 255,532 41, Nevirapine 200mg 1*60 tabs 155,923 26, Efavirenz 600mg 1*30 tabs 146,495 23, Adult second line formulations Abacavir/Lamivudine, Scored, 600/300mg 1*30 tabs 36,288 5, Atazanavir/Ritonavir 300/100mg 1*30 tabs 52,626 8, Lopinavir/Ritonavir 200/50mg 1*120 tabs 54,212 7, Pediatric first line formulations Efavirenz 200mg 1*90 tabs 15,190 2, Abacavir/Lamivudine, Scored, 60/30mg 1*60 tabs 45,388 9, Abacavir/Lamivudine, Scored, 120/60mg 1*30 tabs - 9, Lamivudine/Zidovudine/Nevirapine 30/60/50mg 1*60 tabs 70,993 9, Lamivudine/Zidovudine 30/60mg 1*60 tabs 19,130 3, Nevirapine 10mg/ml 100 ml 1 bottle 7,803 1, Nevirapine 50mg 1*30 tabs 32,524 5,

8 Medical Access Uganda Limited Product Name measure Pediatric second line formulations Lopinavir/Ritonavir 100/25mg 1*60 tabs 15,170 3, Lopinavir/Ritonavir 40/10mg (oral pellets) 1*120 caps 2, Lopinavir/Ritonavir 80/20mg/ml [KALETRA] 60ml 1*5 bottles 1, Min - 3; Max 6 ARV medicines at MAUL All ARV formulations are available at the warehouse. Adult formulations are stocked with in the min - max range of 3 to 6 Months of stock for next six months except for Efavirenz 600mg and Abacavir/ Lamivudine 600/300mg whose stock levels may drop below the minimum level of 3 Months by June Pediatric formulations All pediatric formulations are well stocked above the minimum level of 3 MOS. Stock levels of Efavirenz 200mg, Lopinavir/ritonavir 100/25mg and lamivudine/zidovudine/nevirapine 30/60/50mg need to be monitored to avoid stock outs towards June Abacavir/lamivudine 60/30mg will be replaced with the Abacavir/lamivudine 120/60mg. Shipment of Abacavir/lamivudine 120/60mg is in pipeline. Kaletra syrup will be replaced with Kaletra pellets. MAUL stock for Kaletra pellets is already at the warehouse.

9 D: THIRDLINE ARVS Product Name measure Etravirine (Intellence) 100mg; 120 tablets 1*200 tabs Ritonavir (Norvir) 100mg; 60 tabs 1*60 tabs Raltergravir (Isentress) 400mg; 60 tabs 1*60 tabs Darunavir (Prezista) 600mg, 60 tabs 1*60 tabs Min - 3; Max 6 Notes: Third line commodities at JCRC Most of the commodities are well stocked except for Ritonavir 100mg that is stocked out. Orders have been placed however delivery dates are pending. Short term strategy has been developed to fill the gap for Ritonavir 100mg and saquinavir 50mg as we await delivery of shipments.

10 A: NMS Category measure (Pack) Artemether 20mg + Lumefantrine 120mg ( 6's) 1*30 strips 15,580 7, Artemether 20mg + Lumefantrine 120mg (12's) 1*30 strips 11,492 7, Artemether 20mg + Lumefantrine 120mg (18's) 1*30 strips - 5, Artemether 20mg + Lumefantrine 120mg (24's) 1*30 strips 13,273 46, Artesunate 60mg Powder for Injection, 1 vial 1 vial 498, , Malaria laboratory commodities Malaria Antigen Rapid tests (25 tests) 1*25 tests 249,568 83, Min - 3; Max 6 Notes: Anti-Malaria commodities at NMS Antimalarial Medicines Antimalarials are poorly stocked with stock outs for Artesunate injection, Artemether/lumefantrine 24's, 18's and 12's. All Artemether/Lumefantrine 20/120mg formulations are below 2MoS. Orders through the Global Fund will be received by end of March 2017, However low stock levels persist soon after. Under the GF-PR2, savings have been realized and plans are being finalized to procure Antimalarials for the public sector using this saving. In an effort to reduce the current stock out, Government of Uganda has provided an additional fund to procure ACTs. Malaria RDTs are well stocked and orders will be received in Feb 2017 to ensure adequate availability of this commodity.

11 B: JMS Category measure (Pack) Artemether 20mg + Lumefantrine 120mg (6's) 1*30 strips 12,883 2, Artemether 20mg + Lumefantrine 120mg (12's) 1*30 strips 11,205 2, Artemether 20mg + Lumefantrine 120mg (18's) 1*30 strips 19,690 2, Artemether 20mg + Lumefantrine 120mg (24's) 1*30 strips 18,469 3, Artesunate 60mg Powder for Injection, 1 vial 1 vial 177,010 77, Malaria laboratory commodities Malaria Antigen Rapid tests 1*25 tests 24,503 7, Min - 3; Max 6 Notes: Antimalarial Commodities at JMS JMS is well stocked for all formulations of artemether/lumefantrine 20/120mg. However there are low stock levels for artesunate injection and a risk of stock out for this commodity in the second quarter of There are low stock levels of Malaria RDTs. Efforts are ongoing to obtain emergency order for artesunate injection to relieve the short term shortage as orders are scheduled for August 2017 and Sept Orders for artemether/lumefantrine 20/120mg and Malaria RDTs are expected in April 2017 through GHSC.

12 ICCM A : National Medical Stores /UNICEF Product Name measure (Pack) Closing Bal at 22nd Feb 2017 AMC January 2017 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Non malaria commodities iccm Co-packaged ORS and zinc tablets (2 sachets ORS/10 tab zinc)1 pack 290, , Amoxicillin 250mg 1*10 Tablets Pack of ,932 Amoxicillin 250mg 1*20 Tablets Pack of ,665 Amoxicillin 250mg dispersible tablets Pack of ,299 64, Amoxicillin envelopes Red Pack - 182, Amoxicillin envelopes Green Pack - 228, Malaria commodities Artemether/Lumefantrine 20mg/120mg 6 pack 1*30 strips 8,144 7, Artemether/Lumefantrine 20mg/120mg 12 pack 1*30 4,639 7, Malaria RDTs ( Combined iccm ) 1*25 tests 185,014 45, iccm supplies Safety Boxes Piece 174,175 45, Examination gloves Box of 50 pairs - 45, The additional 11 northern districts expected to start implementation of ICCM in February 2017 were unable to and these are expected to start in March 2017 Antimalarial Deliveries of ACTs is expected in April 2017 equivalent to 1.7 MOS. Total gap 2017 for ACTS, AL 6*1 gap of 81,899 packs equivalent to $786,231, AL 6*2 gap of 92,402 packs equivalent to approx. $1,413,766. Non Malarial Amoxicillin of 100 tabs pack is currently available and is being repackaged into 10's and 20's at the facility level. Stock available is sufficient till mid year. Total gap till end of year $ 1,664, ORS stock is sufficient till May 2017 as per SSR, Distribution has however been halted for the next 2 cycles to enable utilize the facility level stock as it is currently overstocked. Dispensing envelopes are stocked out at the central level, however sufficient quantities have been distributed to the districts. MRDTS Additional order of 96,099 packs of malaria RDTs is expected for GF districts. Date of delivery is to be confirmed.total gap of 506,953 packs equivalent to $2,281,289 is evident till Dec Safety boxes and Gloves Total gap required to avoid stock outs within 2017 is 78,032 packs ( 37,456 $ ) approximately and gloves 542,990 packs (1,580,101 $) The ICCM program in finalizing plans to revise Kit using morbidity data reported from community cases over the current period of the program.

13 A: NMS PART A Category Measure Laboratory Commodities HIV test Kits Determine HIV-1/2 Complete Kit, 100 Tests 100 Tests 73,497 11, HIV, Stat-Pak HIV 1 / 2 Kit, 30 Tests 30 Tests 22,927 1, HIV, Uni-Gold HIV Kit, 20 Tests 20 Tests 3,938 1, viral load commodities Roche Cobas AmpliPrep/Taqman HIV-1TesT, v Test-VL 48 Tests Abbott RealTime HIV-1 Amplification Reagnt Kit,96Test,-VL 96 Tests 2, DBS collect.kit VL sticker,50 Test, Single Use 50 Tests 100 1, Early Infant Diognosis (EID) Commodities Roche Cobas@KIT CAP-G/CTMHIV-1 QAUL 48 test CE-IVD EID 48 Tests DBS Collect.Kit for EID,50 Tests, Single Use 50 Tests CD4+ commodities BD FACS, MultiTest CD3/CD8/CD45/CD4, 50 Tests 50 Tests BD FACS Flow Shelth Fluid 20L Partec-CD4 % Easy Count Kit 100 tests 100 Tests Pima Analyzer CD4 Cartridge Kit, 100 tests 100 Tests Notes: NMS laboratory commodities All HIV Test kits (Determine, Statpak and UniGold) are well stocked. There is a risk of stock out of Determine evident in July No pipeline is available for UniGold as it will be replaced with SD Bio line as recommended in the new HIV testing algorithm. The Order for SD Bioline has been placed through Global Fund. Viral and EID reagents are at a risk of stock out. A request has been made to GHSC and MAUL however, confirmation of delivery dates is pending. Order for CD4 Pima reagents is expected in April 2017

14 A: NMS PART B Category Measure Chemistry commodities Cobas, C311, Creatinine Jaffe' Gen2 (CREA-J), 700 tests 700 Tests COBAS, C311, ALTL, 500 Tests 500 Tests COBAS, C311, ASTL, 500 Tests 500 Tests Human, Auto creatinine 700 Tests Human, GOT (ASAT) IFCC mod LiquiUV Kit, 10 x 10mL 500 Tests Human, GPT (ALAT) IFCC mod LiquiUV Kit, 10 x 10mL 500 Tests Hematology commodities Humacount Diluent 20L 20L 1, Sysmex, Cellpack, 20L 20L Nihon Kohen MEK Diluent 20L 20L Beckman Coulter, AcT5Diff, Diluent 20L 20 L TB Laboratory commodities GeneXpert cartridges 50 Tests Strong Carbol Fuschin 1000ml Solution (ZN) 1000 ML Other commodities Blood Collection Tube, K2 EDTA, 4mL, Lav, 100 Pcs 100 pcs 3,268 4, Syphilis testing devices, 30 tests 30tests 44 1, Min - 3; Max 6 Notes: NMS Laboratory commodities Hematology reagents are well stocked however, Chemistry reagents have low stock levels. Pipeline under GF costed extension is expected in Feb 2017 to increase stock levels to desired levels. A high risk of stock out is likely after June GeneXpert cartridges have less than 3 MOS. Pipeline is expected in March 2017 of up to 10MOS. ZN and FM reagents procured through GF lacked Acid alcohols required to complete the kit. These commodities thus cannot be utilized and a funding gap for the acid alcohols needs to be filled. There is a stock out of syphilis test kits and blood collection tubes. Although pipeline is available for syphilis test kits, blood collection tubes have no pipeline.

15 B: JMS Category Measure HIV test kits Determine HIV-1/2 Complete Kit, 100 Tests 100 Tests 6,576 1, HIV, Stat-Pak HIV 1 / 2 Kit, 20 Tests 30 Tests HIV, Uni-Gold HIV Kit, 20 Tests 20 Tests 2, CD4+ Commodities BD FACS, MultiTest CD3/CD8/CD45/CD4, 50 Tests 50 Tests BD FACS Flow Sheath Fluid 20 Liters Partec-CD4 % Easy Count Kit 100 tests 100 Tests Pima Analyzer CD4 Cartridge Kit, 100 tests 100 Tests Other commodities Blood Collection Tube, K2 EDTA, 4mL, Lav, 100 Pcs 100 Tests Min - 3; Max 6 Notes: JMS laboratory commodities. HIV Test kits are well stocked except Statpak with less than 1 MOS. Inter- warehouse transfer of Stat Pak from NMS to JMS has been initiated. JMS is currently utilizing the stock of Stat Pak at NMS. Delays in delivery of orders for the HIV test kits previously expected Dec 2016 were experienced. These orders are expected by the end of March JMS has received stock of SD Bio line that will be used to replace UniGold. There is a stock out of PIMA and Partec CD4+ test kits and blood collection tubes.

16 C: Medical Access Uganda Limited Category Measure HIV test Kits Determine HIV-1/2 Complete Kit, 100 Tests 100 Tests 5,112 1, HIV, Stat-Pak HIV 1 / 2 Kit, 30 Tests 30 Tests 1, HIV, Uni-Gold HIV Kit, 20 Tests 20 Tests CD4+ Commodities BD-FACS Count Reagent Kit, (Single Tube) 50 Tests BD-FACS Flow Sheath Fluid 20 Liters Partec, Counter CD4, CD4% Easy count kit 100 Tests PIMA Cartridges 100 Tests Other commodities Vacutainer Tubes EDTA 4ML 100 Tests 6, Min - 3; Max 6 Notes: MAUL laboratory commodities HIV test kits are currently well stocked. Orders were placed at the end of Feb 2017 to avert the likely stock out in June Orders for SD Bioline need to be placed to ensure smooth transition from UniGold. There are low stock levels for CD4+ commodities except for the BD FACS count that is well stocked. Orders need to be placed for the other CD+ platforms with no current pipeline.

17 A: NMS Category Measure Medicines for opportunistic infections Fluconazole 200mg Tab (Diflucan) 1*28 tabs 1,205 6, Fluconazole 2mg/ml I.V. Infusion 100ml 1-3, Fluconazole POS 200ml 1 9,375 2, Cotrimoxazole 120mg, 1000 Tabs 1*1000 tabs 5,489 4, Cotrimoxazole 960mg Tabs, 1000 tabs 1*1000 tabs 57,583 19, Min - 3; Max 6 Medicines for opportunistic infections at NMS All formulation of fluconazole and cotrimoxazole except Fluconazole suspension have less than 3 Months of stock. Orders are available for all fluconazole formulations under the Pfizer partnership however, delivery dates pending confirmation. Cotrimoxazole 120mg will be stocked out throughout the second quarter of 2017 as no current orders are available. Cotrimoxazole 960mg shipment is expected through the Global fund grant in March 2017.

18 B: Joint Medical Stores Category Measure Fluconazole 200mg Tab (Diflucan) 1*28 tabs 522 1, Fluconazole 2mg/ml I.V. Infusion 100ml Fluconazole POS 200ml Cotrimoxazole 120mg, 1000 Tabs 1*1000 tabs Cotrimoxazole 960mg Tabs, 1000 tabs 1*1000 tabs 12, Min - 3; Max 6 Medicines for opportunistic infections at JMS Most of the formulations for cotrimoxazole and fluconazole have low stock levels except for cotrimoxazole 960mg. There is a stock out of cotrimoxazole 120mg and Fluconazole IV infusion at JMS. Plans are ongoing to ensure availability of Cotrimoxazole 120mg through using interware-house transfers as we await shipments. Orders are available for all commodities however longer lead times have been realized. Orders of 5,903 and 3,732 are placed for the Cotrimoxazole 120mg equivalent to 7.4 MOS and 4.6 MOS respectively. An order of 9,075 is available for cotrimoxazole 960mg equivalent to 3 MOS.

19 C : Medical Access Uganda Limited Item description Measure Fluconazole 200mg Tab (Diflucan) 1*28 tabs 2,137 1, Fluconazole 2mg/ml I.V. Infusion 100ml Fluconazole POS 35ml Cotrimoxazole 120mg, 1000 Tabs , Cotrimoxazole 960mg Tabs, 1000 tabs ,583 6, Min - 3; Max 6 Medicines for opportunistic infections at MAUL By end of Jan 2017, all formulations for cotrimoxazole and fluconazole were well stocked except for Fluconazole 200mg that was below the 3 minimum months of stock. Pipeline is expected for all the formulations by end of February All formulations are thus expected above the minimum stock level for the period till May 2017 if consumption patterns do not change significantly.

20 Vaccines Item description Measure Penta vaccine (DPT- HEPB +HIB) 10 dose vial 1 vial 493,635 42, Bacillus Calmette -Guerin (BCG) 20 dose vial 1 vial - 18, Hepatitis B Vaccine - 10 dose vial 1 vial 274, , Measles vaccine - 10 dose vial 1 vial 110,640 21, Polio Bivalent vaccine (BOPV) 20 dose vial 1 vial 199,430 27, Inactivate Polio Vaccine (IPV) 1 vial - 35, Human Papilloma Vaccine (HPV) 1 vial 822, , Rabies Vaccine 10 dose vial 1 vial 5,928 2, Tetanus toxoid vaccine (TT) 20 dose vial 1 vial 87,847 13, Pneumococcal conjugate (PCV) 1 vial 1,432, , Min - 3; Max 6 Vaccines at NMS 60% of all vaccine formulations are well stocked. There is however a stock out of BCG, inactivated polio vaccine by the end of February Shipments previously expected in March 2017 are delayed and low stock levels persist for the commodities affected. Orders need to placed for commodities now to avoid stock outs for 60% of commodities by June 2017.

21 A: NMS Item Description Measure Reproductive Health Commodities Depo-Provera 1 vial 560,800 74, Implants (Implanon) 1 vial 17,039 4, IUD - Copper Containing Device TCU380A*** Male Condom (52MM with and without Logo) 1 3,480,768 4,619, Mama Kit 1 9,602 19, Levonorgestrel 750mcg (Emergency Contraceptive)*** Misoprostol 200mcg Tabs 100 4, Combined Oral Contraceptives (Microgynon) 1 cycle 6 16, Min - 3; Max 6 Reproductive health commodities at NMS Most of the commodities are stocked out except for Depo-Provera, implanon and Misoprostol that are currently available however at a risk of stock out starting April Inter-ware house transfers are being processed for emergency contraceptives and microgynon from UHMG to NMS. Global Fund Male condoms will be availed to NMS as fast as released by NDA from quarantine. Mama Kits are delivered using Just-in -time delivery. Call off for the FY 2016/2017 are; 208,500 kits and 196,000 kits.

22 B: UHMG Item Description Measure Depo-Provera 1 vial - 233, Implants (Implanon) 1-24, IUD - Copper Containing Device TCU380A 1 99,249 7, Male Condom (52mm with and without Logo) 1 172,565,304 13,467, Levonorgestrel 1.5 mcg(emergency Contraceptive) 1 150,839 17, Misoprostol 200mcg Tabs ,602 2, Combined Oral Contraceptives (Microgynon) 1 410, , Female Condoms 1 1,728, , Norigynon 1 67,500 22, Noristerat 1 209,794 4, Jadelle 1 91,000 23, Min - 3; Max 6 Reproductive health commodities at UHMG UHMG, has most of the selected commodities available except for Depo provera and Implanon that are currently stocked out. Norigynon and Jadelle are at a risk of stock out will no current pipeline. Pipeline is available for Depo-Provera through GHSC and however delivery dates are pending. Of the 172,565,304 male condoms available by the end of January 2017, only 1,098,640 were available for distribution and the rest under quarantine. Condom lubricants (964,000 sachets) were received in Jan Norigynon is at a risk of expiry in 18 months (June 2018) a strategy to utilize the available stock needs to be developed.

23 First Line TB Medicines TB MEDICINES AT NMS Item Description Pack size Isoniazid 100mg 1*100 tabs Isoniazid 300mg 1*672 tabs FDC RH (150/75) mg 1* 672 tabs 34,416 1, FDC RHE (150/75/275) mg 1* 672 tabs FDC RHZ (60/30/150) mg 1* 84 tabs 9, FDC RH (60/30) 60+30mg 1* 84 tabs 21,359 1, FDC RHZE (150/75/400/275) mg 1*672 tabs 10,996 1, Streptomycin 1000mg 100 vials 6, Min - 3; Max - 12 Notes: First line Anti-TB medicine Most of the medicines are well stocked except for isoniazid 100mg, Isoniazid 300mg and RHE (150/75/275) that are stocked out. pipelines are available for this commodities under the global fund however stock out is projected to persist till April 2017 when the first consignments are expected. RHZE is being closely monitored as it is at a risk of stock out. A new order was placed with global Fund however, confirmation of delivery dates is pending. The orders for the new short duration treatments have been placed for the following commodities: RH 75/150; RHZ 75/50/150. Transition to the new treatment guidelines is being closely monitored to prevent wastage of current incountry stock. GOU gap fill for Pyridoxine and ethambutol is required to ensure continued treatment success and patient adherence to treatment. MDR TB Medicines Item Description Pack size Capreomycin 1000mg Powder for injection 1 1 vial Kanamycin 1000mg Powder for injection 1*10 vials Cycloserine 250mg Capsule(s) 100 1*100 caps 3, Ethionamide 250mg Film coated tablet(s) 100 1*100 tabs 4, Levofloxacin 250mg Film coated tablet(s) 100 1*100 tabs Moxifloxacin 400mg Film coated tablet(s) 5 1*5 tabs P-amino salicylate sodium salt 4000mg Powder 1*25 sachets Pyrazinamide 400mg Film uncoated tablet(s) 1*672 tabs Min - 3; Max- 12 Most of the MDR-TB medicines were well stocked by end of Jan 2017 except Pyrazinamide, Moxifloxacin and Levofloxacin that were stocked out. Stock out of levofloxacin, and pyrazinamide is attributed to shipment delays previous expected in Jan Moxifloxacin previously available was distributes to various facilities for use in other recommended indications. An emergency procurement through GOU has been placed for Kanamycin and order placed through Global Fund to fill the current commodity need for Kanamycin. Confirmation of delivery dates is pending form the supplier.

24 Facility stock status report MDR TB medicines facility stock status as of 1st February 2017 Regimen measure Total stock available Total Stock Net AMC MOS Kanamycin 1g Vial 10 1, Capreomycin 1g vial Cycloserine 250mg tab 100 1, Ethionamide 250mg tab 100 1, Levofloxacin 250mg tab Moxifloxacin 400 mg tab PAS acid sachet eq. to 4 g amino salicylic acid Pyrazinamide 400mg Notes: TB facility stock status Most of the commodities are well stocked above 2 MOS except for Levofloxacin 250mg. Levofloxacin levels are low due to delayed receipt of shipment at the central level. Stock levels are expected to improve with the central level delivery to the facilities. Para aminosalicyclic acid stock levels are very high and stock levels need to be monitored.

25 WAOS ARV medicines facility stock status as of 1st February 2017 Facility Stock Status Adult Formulation Total Closing Balance at Facilities Facility AMC - District MoS of the stock at facilities MoS Needed to have 4 MoS in facilities below 4 MoS MoS of Excess Stock at Facilities with 4 MoS Net Stock Required to Fill Gap Net MOS at the facility Abacavir/Lamivudine (ABC/3TC) 600mg/300mg 58,881 13, Atazanavir/ritonavir (ATV/r) 300mg/100mg 62,546 17, Efavirenz (EFV) 600mg 597, , Lopinavir/Ritonavir (LPV/r) 200mg/50mg 57,280 19, Nevirapine (NVP) 200mg 285,616 64, Tenofovir/Lamivudine (TDF/3TC) 300mg/300mg 689, , Tenofovir/Lamivudine/Efavirenz (TDF/3TC/EFV) 300mg/300mg/600mg 814, , Zidovudine (AZT) 300mg 2, Zidovudine/Lamivudine (AZT/3TC) 300mg/150mg 320,225 73, Zidovudine/Lamivudine/Nevirapine (AZT/3TC/NVP) 300mg/150mg/200mg 598, , Pediatric Abacavir (ABC) 60mg 2, Abacavir/Lamivudine (ABC/3TC) 60mg/30mg 211,280 37, Efavirenz (EFV) 200mg 49,316 8, Lopinavir/Ritonavir (LPV/r) 100mg/25mg 36,717 7, Lopinavir/Ritonavir 80/20ml oral syrup 7,190 1, Nevirapine (NVP) 10mg/ml oral susp. 35,803 6, Nevirapine (NVP) 50mg 44,947 10, Zidovudine/Lamivudine (AZT/3TC) 60mg/30mg 138,768 10, Zidovudine/Lamivudine/Nevirapine (AZT/3TC/NVP) 60mg/30mg/50mg 251,669 51, OI Medicines Fluconazole 200mg 22,389 5, Fluconazole IV 7,635 1, Fluconazole oral solution 5, Cotrimoxazole 120mg 25,221 4, Cotrimoxazole 960mg 70,375 26, Dapsone 100mg 22,749 3, HIV/AIDS facility stock status Most of the commodities are well stocked at the facility level except for Cotrimoxazole 960mg, Tenofovir/Lamivudine/Efavirenz 300/300/600mg and Lamivudine/zidovudine/Nevirapine 150/300/200mg with low stock levels. Stock redistribution is key in ensuring all the stock is usable. As reflected, there are facilities with excess stock and those that have less than 2 MoS to stock outs. With the receipt of commodities from Global Fund, Government of Uganda and PEPFAR stock situation at the facility level is expected to remain stable.