Web-Based ARV Ordering and Reporting System (WAOS) Report

Transcription

1 Web-Based ARV Ordering and Reporting System (WAOS) Report April 2017 May 2017 Uganda Ministry of Health STD/AIDS Control Programme P.O. Box 7272 Kampala Uganda Phone: Website: The Web-Based ARV Ordering and Reporting System (WAOS) is the official Ministry of Health (MoH) ARV ordering and reporting system hosted within the District Health Information Software (DHIS2). Since 2014, the Ministry of Health has used this system to support health facilities to order and report on utilistion of ARVs and medicines for treatment of opportunistic infections. The web based orders are submitted at different levels of the health service delivery system. Healthfacilities with computers and internet connectivity submit orders directly in to the web-based system. Facilities without computers and internet connectivity submit hard copies of the orders to the district and with the support of the district biostatisticians, these orders are transcribed into the Web based system. In addition, hard copy orders may be submitted to the warehouses/regional offices that are inturn entered in to the web bases sytem. The WAOS bimonthly report highlights facility reporting rates, patient numbers and stock status of key indicator ARV medicines. The report provides recommendations that require action from various stakeholders. Detailed analysis of facility stock status highlights order quality issues, stockout and overstocked commodities. Report highlights A total of 1,661 facilities submitted an order/report this cycle, representing 96% of the 1,734 ART sites that have been active for the last one year About 95% of the reports were submitted through WAOS About 62% of facilities submitted order before/by order deadline. This is still considered low as many facilities stand a risk of stock out and late supply by the respective warehouse. A total of 93% of the facilities that ordered reported on stock status of TDF/3TC/EFV 300mg/300mg/600mg. The percentage of facilities that reported a stock out of TDF/3TC/EFV at the end of April May cycle has reduced to 4% compared to 12% in the previous cycle. Most of the pediatric formualtions were to be over stocked at the health facilities including Zidovudine/Lamuvudine 60mg/30mg, Zidovudine/Lamuvudine/Nevirapine 60mg/30mg/50mg and Abacavir/Lamuvudine 60mg/30mg. Patient numbers reported in HMIS reports were 9% lower than WAOS reported patient numbers. The variation was mostly attributed to adult patient numbers while there was no significant variation in the first line pediatric patient numbers reported in both the HMIS and WAOS reports. 1

2 There is need to continuously support facilities to ensure complete, accurate and harmonized reporting of patient numbers in both HMIS and WAOS reports. Use of the system a) Reporting rates and timeliness of reporting. Reporting rates were analyzed based on active ART facilities as of May These include facilities that submitted at least one order/report in the last twelve months. The number of active facilities is 1,734 facilities. The overall reporting rate in this period is at 96% while timeliness of order submission is at 62%. Overall timeliness of order submission was affected by the low timeliness in the private for profit facilities which is still at 22%. A detailed analysis of each sector for the selected indicators are shown in table 1 below. Table 1: Status of Reporting by category Reporting rates by facility type ALL SITES (TOTAL) GOVERNMENT FACILITY OWNERSHIP MEDICAL BUREAUS NGO PNFP PRIVATE FOR PROFIT Number of active ART sites as per the Master List Oct 14 1,770 1, Number of active ART sites Feb May ,734 1, % that reported this cycle 96% 94% 99% 99% 100% % that reported through WAOS 95% 99% 84% 82% 99% % that ordered/reported by warehouse deadline 62% 65% 67% 52% 22% % that reported patient data 96% 98% 95% 93% 74% b) Reporting rate by warehouse / supplier Table 2 shows overall reporting rates for facilities receiving supplies from NMS, JMS and MAUL over the past seven cycles. overall reporting rate has remained at 96% of the active ART site Table 2:WAOs warehouse reporting rates and reported patient numbers Active ART Facilities No. Reporting Reporting rates *Patient Numbers Overall 1,736 1,661 96% 1,066,595 JMS % 103,185 MAUL % 266,634 NMS 1,246 1,172 94% 696,776 *Patient numbers as reported in WAOS April-May

3 Figure 1: Overall reporting rates across all three central warehouses for the last one year W AREHOUSE R E P O RT ING R ATES NMS JMS MAUL 120% 100% 80% 100% 100% 99% 100% 97% 94% 60% 40% 20% 0% A P R - M A Y J U N - J U L A U G - S E P O C T - N O V D E C - J A N 2017 F E B - M A R 2017 A P R - M A Y 2017 As seen in Fig.1 above, Medical access has generally maintained stable reporting rate across the period. JMS has registered significant improvement while NMS has declines from 97% in tbe previous cycle to 94%. b) Facility stock status Table 3 shows the overall stock status of medicines at facilities during the reporting period. Generally, many facilities reported an overstock of adult formulations while some few reported stock outs of the adult formulations. A detailed review of TDF/3TC/EFV stock status show that, 25% had over 4 months of stock, 33% had between 2 and 4 months of stock, 38% had less than 2 MOS but greater than 0 months of stock on hand. At a national AMC of 424,853 additional, 2 months of stock ( Approx 840,000 packs eqv to $ 7.3M) are required to increase the stock levels to 4 months of stock in all the facilities that were both below 2 and at 0 months of stock. The excess stock available in the facilities with stock above 4 months of stock was equivalent to 0.3 months of stock.( Refer to table 3 ) Similarly, many facilities reported an overstock of majority of the pediatric formulations. Specific to Lopinavir/ritonavir suspension, facilities reported a national AMC of 1,434. Therefore, an additional 3.3 months of stock are required to attain the desired stock levels of 4 months of stock in facilities that reported stock levels below 2 MOS. Redistribution during this cycle may not work for LPV/r since excess stock was equivalent to only 0.1 months of stock. In addition, the HIV consolidated guidelines reccommends replacement of LPV/r suspension with LPV/r pellets for use in children below the age of three years. Health facilities are expected to order for this product inorder to facilitate smooth transistion. A detailed facility stock status report will be shared with the districts and IP inorder to guide stock redistribution and minimize stock outs and expiries. 3

4 AMC Figure 2: Trends in TDF/3TC regimens average monthly consumptions The percentage of patients on TDF/3TC/EFV contributing to the total number of patients on TDF based regimens has increased (from 82% to 85% since June ). Howerver the low stocks for TDF/3TC/EFV in the country in the past months ending and at the beginning of 2017 led to an increase in the use of TDF/3TC combined with EFV to substitute for TDF/3TC/EFV as reflected in increased TDF/3TC AMCs. This substitution should be carefully coordinated to ensure that stock for patients in need of TDF/3TC and NVP or TDF/3TC with LPV/r are not depleted. In addition, consumption reports for substituted products should be well aligned to avoid over and under reporting for respective formulations TDF based regimen AMCs 500, , , , , , , , ,000 50,000 - Jul Sep Nov Jan 2017 Mar 2017 May 2017 Tenofovir/Lamivudine (TDF/3TC) 300mg/300mg Tenofovir/Lamivudine/Efavirenz 300mg/300mg/600mg 4

5 Table 3; Facility Stock Status as of 1 st June 2017 Facility Stock Status Category Months of stock : Min 2-Max 4 No of facilities MoS MoS WAOS Facility AMC - National Additional stock required Excess stock ( For possible redistribution ) 0 MoS >4 MoS Adult Abacavir/Lamivudine (ABC/3TC) 600mg/300mg % 20% 19% 42% 12, Atazanavir/ritonavir (ATV/r) 300mg/100mg 701 4% 21% 26% 50% 19, Efavirenz (EFV) 600mg 1,248 3% 22% 21% 54% 150, Lopinavir/Ritonavir (LPV/r) 200mg/50mg 617 8% 22% 24% 46% 19, Nevirapine (NVP) 200mg 1,124 4% 18% 22% 57% 68, Tenofovir/Lamivudine (TDF/3TC) 300mg/300mg 1,295 4% 24% 22% 50% 181, Tenofovir/Lamivudine/Efavirenz 300mg/300mg/600mg 1,546 4% 38% 33% 25% 424, Zidovudine (AZT) 300mg 12 8% 25% 8% 58% Zidovudine/Lamivudine (AZT/3TC) 300mg/150mg 1,120 3% 21% 22% 54% 82, Zidovudine/Lamivudine/Nevirapine 300mg/150mg/200mg 1,393 3% 26% 32% 40% 209, Pediatric Abacavir (ABC) 60mg 13 38% 31% 23% 8% Abacavir/Lamivudine (ABC/3TC) 60mg/30mg 1,090 5% 20% 24% 51% 43, Efavirenz (EFV) 200mg % 20% 17% 51% 9, Lopinavir/Ritonavir (LPV/r) 100mg/25mg 369 9% 22% 18% 51% 7, Lopinavir/Ritonavir 80/20ml oral syrup 25 20% 16% 32% 32% 1, Nevirapine (NVP) 10mg/ml oral susp. 1,139 11% 18% 18% 53% 6, Nevirapine (NVP) 50mg % 26% 18% 34% 13, Zidovudine/Lamivudine (AZT/3TC) 60mg/30mg 545 6% 14% 15% 64% 11, Zidovudine/Lamivudine/Nevirapine 60mg/30mg/50mg 1,168 5% 21% 24% 50% 47, OIs Fluconazole 200mg % 24% 17% 42% 5, Fluconazole IV 97 19% 18% 14% 49% 1, Fluconazole oral solution % 10% 14% 58% Cotrimoxazole 120mg 1,276 14% 20% 21% 45% 4, Cotrimoxazole 960mg 1,495 6% 27% 35% 31% 27, Dapsone 100mg % 13% 27% 40% 3,

6 Patient statistics These patient statistics are based on all active ART facilities that reported on patient numbers in the last two cycles ending May The patient numbers are from reports submitted through WAOS as well as paper and other electronic orders/reports submitted to the warehouses. a) Patient numbers reported in the public and private sector as of 1 st June 2017 Table 4 presents a summary of WAOS reported patient numbers compared to patient numbers as reported in DHIS2/HMIS reports. The overall ACP patients are 9% lower than the WAOS reported numbers. ACP patient numbers on adult 1 st line regimens were 9% lower than WAOS reported numbers while pediatric 1 st line patients were almost similar to those reported in WAOS. Table 4: Patient numbers in both the private and public sector Current number of ART patients ACP 31 st March 2017 WAOS 1 st June 2017 % Difference 980,615 1,066,595-9% Total number of ART patients 915,528 1,000,425-9% Total Adult ART patients 65,087 66,170-2% Total Pediatric ART patients 884, ,012-9% Number of Adults on 1st Line 30,839 35,413-15% Number of Adults on 2nd Line 59,786 59,766 0% Number of Children on 1st Line 5,301 6,404-21% Number of Children on 2nd Line Next Steps The district together with IPs to support facilities to redistribute ARVs that are over stocked with a focus on Nevirapine 50mg tablet and Nevirapine suspension District and IPs to support health facilities to order for LPV/r pellets inorder to facilitate smooth transition District Biostiatisticans to support health facilities to provide accurate patient number information Bistatisticians should review data entered in WAOS before submission to minimize data entry errors IPs supporting the private sector should focus on ensuring facilities submit orders in a timely manner Ministry of health and UHSC will facilitate training on the new Web based ordering system and ARV order and report form IP to print and ensure dissemination of the June 2017 verison of the ARV and OI order and report forms IPs to prioritise training of Logistics officers during the roll out and dissemination of the HIV consolidated guidelines APPENDIX A detailed facility level stock status report to help facilitate stock redistribution was shared with all The DHOs, Implementing Partners, Regional Pharmaceutical Monitoring Teams, and Medicines Management Supervisors 6