Global Health Supply Chain Program

The USAID Global Health Supply Chain Program - Procurement and Supply Management (GHSC-PSM) project aims to strengthen the supply chain of the Ministry of Health, National HIV/AIDS Program (NAP) and Guatemalan Social Security Institute, to effectively manage the medicines and products necessary to support the HIV Strategy 95-95-95.

Under the program, the Government of Guatemala finances most of its own acquisition of antiretrovirals (ARV) and other products for HIV/AIDS in coordination with the Strategic Fund of the Pan American Health Organization (PAHO) and eventually with donations from the Global Fund and PEPFAR/USAID. GHSC-PSM also supports supply management in the areas of reproductive health and COVID control and prevention.

GEOGRAPHICAL AND DEMOGRAPHIC APPROACH

At the national level, PSM provides technical assistance for the development of estimates and purchasing plans for the supplies required for HIV; strengthens logistics information system tools; and improves storage practices, among others. Its main counterparts are the MSPAS Logistics Management Unit (UGL) and the PNS.

At the local level, Guatemala has 17 Comprehensive Care Units (UAIs) that care for people with HIV, of which 11 receive technical assistance (TA) and supervision by the project to improve the logistics system, the management of antiretroviral drugs and the information system for supply management. Seven of the UAIS also receive TA from USAID for the provision of HIV services. They are located in the Departments of Guatemala, Sacatepéquez, Retalhuleu, Quetzaltenango, Cuilapa, San Marcos and Puerto Barrios, where 48% of patients are concentrated.

CONTEXT AND CHALLENGES

During the last year, the MSPAS in Guatemala has gone through various changes, which have impacted the logistics flow and management of supplies. GHSC-PSM has sought to provide support by monitoring the forecasting and supply plan, as well as by hiring a logistics consultant for a limited time, who works directly with the PNS to facilitate the logistics of antiretroviral distribution to the clinics.

Work is required in other areas including improving communication and visibility of information between the PNS and the UAIs to facilitate the logistics and management of antiretrovirals in the clinics; establishing official guidelines that allow the implementation and sustainability of the PrEP and multi-month dispensing (MMD) initiatives, especially to avoid the fractioning of the bottles of antiretrovirals. GHSC-PSM continues to work in coordination with other partners to promote the official approval of these guidelines.

APPROACH AND RESULTS

GHSC-PSM played a key role in planning the transition to the more effective Tenofovir, Lamivudina, Dolutegravir (TLD) treatment by actively supporting the forecast and supply plan processes at PEPFAR-prioritized sites. On-site logistics staff and the improvement of an online tool to capture and analyze monitoring results has strengthened logistics management processes. Data visibility remains a key goal and focus through the adoption of low-cost logistics data management tools. The main achievements to highlight are:

• 87% of the patient cohort is using TLDs at the end of Q4.
• Completed forecast and supply plan exercises for the year 2023, for antiretrovirals (ARVs), viral load, proviral DNA and CD4.
• Processed PEPFAR/USAID donation of 107 viral load kits and 35,462 bottles of TLD in 90-tablet bottles.
• Achieved coverage of 11 PEPFAR prioritized sites (73% of the total) with incorporation of three additional GHSC-PSM logistics consultants to the field team to complete a total of nine.
• Completed the pilot test implementation of a patient cohort registration tool (ANNEX G), which allows the registration of treatment schemes with a standard nomenclature, which facilitates their complication and analysis.