Effective supply chain management remains the most significant challenge facing HIV/Aids treatment in developing countries, particularly those in sub-Saharan Africa, and is critical to realising the global goal of an Aids-free generation by 2030, says former Anglo American chief medical officer Dr Brian Brink.

He adds that many clinics in sub-Saharan Africa are left without stock of antiretroviral (ARV) medication for as long as six weeks, which could result in those communities developing resistance to the medication, thereby compounding the challenges of HIV/Aids treatment.

“There needs to be a supply chain that can effectively . . . deliver [ARVs] from the manufacturing facility all the way to the point of care,” Brink asserts, adding that significant investments must be made in supply chain management to meet the 2030 goal.

Healthcare supply chain management company Imperial Health Sciences MD Dr Iain Barton points out that regulations often cause bottlenecks in the supply chain.

As an example, he notes that Kenya’s regulations require pharmacists to manage medical warehouses. “However, pharmacists are not trained in warehouse management” Barton states, adding that this removes a significant number of qualified pharmacists from the task of providing care and treatment for patients.

Meanwhile, Brink notes that the current scale of treatment must be increased if it is to achieve the goal of having all HIV-positive individuals on ARV treatment to achieve an Aids-free generation by 2030.

Brink asserts that the spread of the virus could be stopped if the number of HIV-positive individuals receiving ARV treatment is doubled, thereby ending the Aids epidemic.

Barton highlights that South Africa is the exception in sub-Saharan Africa in terms of effective supply chain management, as a significantly larger employment base has been developed by allowing for private-sector participation in treatment campaigns. In many other countries in the region, treatment is administered solely by the public sector.

Much of the treatment scale-up in South Africa was achieved through the public health service, but it is imperative that there is greater private-sector involvement to reach the 2030 goal, Brink argues.

He suggests that a closer working relationship between the public and private sectors will allow for the development of strategies that will take advantage of individual strengths and mitigate weaknesses.

Meanwhile, Barton points out that another factor contributing to South Africa’s treatment success is the population’s access to about 2 500 retail pharmacies across the country, compared with Kenya, which has about 175.

He also suggests that more people need to be trained to monitor and review individuals undergoing ARV treatment, as well as screen patients and escalate treatment.