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COMMENTARY

Strategies to reduce risks in ARV supply chains in the developing world

Chris Larson, Robert Burn, Anja Minnick-Sakal, Meaghan O'Keefe Douglas and Joel Kuritsky
Global Health: Science and Practice December 2014, 2(4):395-402; https://doi.org/10.9745/GHSP-D-14-00105
Chris Larson
aUPS, Columbus, Ohio, USA
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Robert Burn
bManagement Sciences for Health, Arlington, VA, USA
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Anja Minnick-Sakal
cFormerly with the United States Agency for International Development, Washington, DC, USA
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Meaghan O'Keefe Douglas
dUnited States Agency for International Development, Global Health Fellows Program, Washington, DC, USA
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  • For correspondence: medouglas@usaid.gov
Joel Kuritsky
eUnited States Agency for International Development, Washington, DC, USA
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  • Figure 1.
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    Figure 1.

    2013 Pricing (US$) for Adult and Pediatric Formulations of Fixed-Dose Combination Antiretroviral Drugs,a Pooled Procurement vs Annual Tenderb

    a Adult formulation: Lamivudine/Nevirapine/Zidovudine 150/200/300 mg dispensed in 60 tabs; pediatric formulation: Lamivudine/Nevirapine/Zidovudine 30/50/60 mg dispensed in 60 tabs.

    b Pooled procurement across PEPFAR-supported countries; annual tender in an East African country.

  • Figure 2.
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    Figure 2.

    Catchment Area of Regional Distribution Centers

    To support global pooled procurement and reduce turnaround times for delivery of ARVs, the Supply Chain Management System project established 3 regional distribution centers (RDCs) in Ghana, Kenya, and South Africa. These facilities hold strategic stock, provide regularly scheduled shipments to neighboring countries, and expedite emergency orders to prevent stock-outs. To provide a sustainable resource, the RDCs were established as independent commercial enterprises, attracting major private-sector pharmaceutical clients.

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    Figure 3.

    Proportion of ARV Shipments Delivered On Time, Manufacturers Versus SCMS Regional Distribution Centers, January 2007–March 2012

    Abbreviations: ARV, antiretroviral; RDC, regional distribution center; SCMS, Supply Chain Management System.

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    Figure 4.

    Number of Bottles of ARVs Transported by Air and Ocean and Proportion of Ocean Shipments, 2006–2014

    Abbreviation: ARV, antiretroviral.

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    TABLE. ARV Supply Chain Risks and Corresponding Risk Mitigation Strategies by the SCMS Project
    Risk CategoryARV Supply Chain RisksRisk Mitigation Strategies
    Supply• Production delays• Multiple-source procurement
    • Shipping delays• Pooled procurement
    • Use of RDCs
    • Flexible product specification
    Demand• Expanding treatment programs• Frequent update and review of supply plans
    • Inaccurate and/or delayed demand forecasting and supply planning• Regional aggregation of country forecasts and supply plans for pooled procurement
    • Burdensome procurement procedures• Restocking RDCs based on analysis of likely demand (as opposed to firm orders)
    Cost• High per-unit product costs• Pooled procurement based on aggregate demand plans
    • High shipping costs• Freight consolidation and ocean shipping
    • Abbreviations: ARV, antiretroviral; RDC, regional distribution center; SCMS, Supply Chain Management System.

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Global Health: Science and Practice: 2 (4)
Global Health: Science and Practice
Vol. 2, No. 4
December 01, 2014
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Strategies to reduce risks in ARV supply chains in the developing world
Chris Larson, Robert Burn, Anja Minnick-Sakal, Meaghan O'Keefe Douglas, Joel Kuritsky
Global Health: Science and Practice Dec 2014, 2 (4) 395-402; DOI: 10.9745/GHSP-D-14-00105

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Strategies to reduce risks in ARV supply chains in the developing world
Chris Larson, Robert Burn, Anja Minnick-Sakal, Meaghan O'Keefe Douglas, Joel Kuritsky
Global Health: Science and Practice Dec 2014, 2 (4) 395-402; DOI: 10.9745/GHSP-D-14-00105
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