Monitoring and Uptake

Robust monitoring to ensure uninterrupted access to optimal products for patients

Monitoring uptake is critical as there are often disconnects between procurement and consumption. If uptake occurs at a different pace than planned, it could lead to wastage or stock-outs. Therefore, early detection and risk mitigation can contribute to more rapid treatment and product uptake.

Monitoring and Uptake Checklist

Develop a comprehensive monitoring plan factoring in the number of patients, facilities dispensing product, and stock availability

Consider using a tool to track uptake trends on a more frequent basis than regular reporting in the early stages of rollout to monitor uptake against planned usage and available supply

Monitor consumption patterns and support adjustment of supply plan accordingly (closely monitor high-volume facilities as these greatly impact stock availability) (e.g. CHAI Rapid Consumption Monitoring Tool)

In the event of slower uptake than planned, consider strategies listed in the toolkit below to drive uptake and avoid expiries and waste

Monitor supplier performance to ensure suppliers are delivering according to their contractual obligations

Develop and implement a robust pharmacovigilance system to monitor adverse drug reactions, drug resistance, toxicities, and treatment failure, in line with World Health Organization (WHO) guidance

Use the links below to download the entire HIV New Product Introduction Guide or the Monitoring & Uptake chapter only

Monitoring and Uptake Tools and Resources

To ensure that product uptake is well monitored and relevant data is collected, both electronic and paper based tools used to collect essential supply chain logistics and patient information should be updated to incorporate the new product. These tools include facility ordering forms, stock cards, pharmacy registers, dispensing registers, warehouse registers, inventory management systems, and patient registers, which track which regimens each patient.

Featured Resource: CHAI Rapid Consumption Monitoring Tool 

As national programs continue to rollout new generic ARVs, there is a need for routine, careful monitoring of product uptake to ensure the smooth and sustained adoption of optimal formulations. During new product initiation in country, there are two common issues that may arise: overconsumption (i.e., actual demand exceeds anticipated demand) and underconsumption. (i.e., actual demand lags anticipated demand).

The CHAI Rapid Consumption Monitoring Tool is a simple tool for programs that have begun to rollout new ARVs to compare the actual consumption of a new product at the facility level against forecasted uptake trends in the hopes of identifying any potential issues of under consumption or overconsumption. Below are two outputs of the tool: 1) consumption trends by drug by facility and 2) a facility overview across all drugs:

 

Watch a Webinar featuring the Rapid Consumption Monitoring Tool

Rapid Consumption Monitoring Output - Consumption Trends by Drug by Facility
Rapid Consumption Monitoring Output - Facility Level Across All Drugs
 

Featured Resource: CHAI National Stock Status Dashboard

Keeping an adequate stock of ARVs on hand is important for multiple reasons. Too much stock, and programs run the risk of products expiring before they can be used. Too little stock, and programs run the risk of a stockout and patients going without vital medicines. Monitoring the stock on hand (SOH) of ARVs is an exercise that programs should conduct on an ongoing basis to ensure that resources are being used wisely.

 

The CHAI National ARV Stock Status Dashboard is a simple tool designed for programs to monitor the SOH of ARVs at the national level. The tool shows, over a two year period, when stocks are likely to exceed maximum stock levels (i.e., potential wastage) and when stocks will dip below minimum required levels (i.e., an impending stockout), based on user-inputted current SOH, expected deliveries, and average monthly consumption (AMC). Watch a webinar featuring the National Stock Status Dashboard.

 

Adverse Events and Monitoring Tools & Resources

 

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Prescribers should be provided with clear guidance on the national recommendations for use of new products in special populations, including TB co-infected patients and pregnant women, during rollout trainings and mentorship activities. Training should include guidance on when and how to use adverse event reports or other monitoring and pharmacovigilance reports:

 

Improving Pharmacy Practices

As part of product rollout and monitoring activities, ensure that ordering and management practices at the facility-level support appropriate prescribing and uptake objectives. This link can be key to ensure patients are given accurate information, medicines are appropriately dispensed, and sufficient stock is maintained at the facility level to meet uptake targets. Reviewing orders from facilities, as is the practice in the MoH in Uganda, to check orders are appropriate is one approach. Pharmacy mentoring is another tool to improve pharmacy practices. An example pharmacy mentorship manual from Ethiopia can be accessed below:

 

Case Studies

 

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Case studies that provide lessons learned and best practices for monitoring and uptake when introducing new products:

 

ARV Procurement Working Group (APWG)

Since 2011, the Pediatric ARV Procurement Working Group (PAPWG), whose members include the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), Unitaid, United States Agency for International Development (USAID), the Partnership for Supply Chain Management (PfSCM), and CHAI, among others, made significant gains in stabilizing the pediatric ARV market by aligning demand and supply sides of the market.

In 2016, the PAPWG expanded its scope to include adult ARVs facing similar market conditions and was renamed the ARV Procurement Working Group (APWG) to reflect the expanded scope and mission. The group’s original objectives and operating principles continue to guide the work and ensure increased market stability. Engagement within this forum is essential to support coordinated uptake of new products.

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Since March 2017, the APWG has been publishing a quarterly rolling forecast for all ARVs (outside of non-essential pediatric formulations) based on anticipated procurement plans of member organizations. This forecast is valuable for suppliers and procurers alike. By sharing forward-looking plans on projected orders and scale-up plans across countries, suppliers have better information on which orders to scale-up capacity. This helps to ensure supply keeps up with demand. During previous transitions to new ARVs, suppliers only saw orders once they were placed, and not pipeline orders, so they may have experienced capacity issues as orders spiked in line with demand. The new process is designed to mitigate these challenges which impacts both suppliers and buyers. The forecast will also make it possible to see on a quarterly basis which products may be vulnerable to long lead times due to 1) not having a critical mass of orders or 2) capacity challenges. This visibility allows appropriate conversations and actions to be carried out in response. When introducing new ARVs, country programs are encouraged to liaise with the APWG members, such as CHAI or the Global Fund, to communicate scale-up plans and to contribute efforts towards promoting global supply security during new product transitions:

 

A goal of this toolkit is to stimulate conversations between government, partners, and communities on new product introduction. Please feel free to share any thoughts, questions, or additional resources for consideration by contacting us via email at any time: HIVToolkit@clintonhealthaccess.org.

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Rapid Consumption Monitoring Output - Consumption Trends by Drug by Facility