Multi-month HIV Prescriptions Benefiting Patients and Health Workers

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February 4, 2022
Lead Paragraph/Summary

Access to extended antiretroviral therapy (ART) refills, or multi-month dispensing (MMD), is being accelerated in Botswana. Jwaneng Mine Hospital is one of the largest health facilities in the country serving a population of over 18,000 people and provides life-saving ART to at least 710 HIV clients.

To make it easier for these clients to get their medications and stay on treatment, the hospital offers MMD of ART to stable clients. Medically stable clients can receive six months of ART, thus eliminating the need for monthly clinic visits. “This has made our work easier because when you supply clients with drugs for a period of three months, it means less people are coming through to the facility and it promotes a self-care model. Clients take ownership of and responsibility for their treatment,” said Taolo Gabasiane, nurse prescriber at Jwaneng Mine Hospital. “When we told clients that they were now going to be supplied with medication for three months, they were happy.”

Taolo explained that during the monitoring and support visits, clients’ perspectives on how the MMD has impacted their access to ART treatment were noted. Patients reported that the MMD allowed them to access services in a timely manner, with no congestion on refill days. Other patients remarked that MMD instilled in them a feeling that they are trusted partners in the entire ART care and treatment process. This in turn has simplified the work of health care workers because patients now own the treatment initiative and have become more responsible with their medication.

Improved quality of treatment

MMD has increased the quality of treatment and care for ART patients, as health care workers now have enough time to interact with patients and address their specific needs. Botswana Health System adopted differentiated service delivery models, including the multi-month dispensing approach to improve the impact of the country’s HIV response in meeting the UNAIDS 2030’s 95-95-95 targets through improved treatment adherence and improved health system efficiencies. The MMD comes in two categories: three months (3MM) and six months (6MM). The choice of either category depends mainly on the patient meeting set eligibility criteria and availability of the drugs. As a result, the supply chain plays a pivotal role in ensuring that MMD is achieved across the health system.

GHSC-PSM worked with the Ministry of Health and Welfare (MOHW) to ensure that MMD implementation is clear and fluent. The support includes successful development of the MMD eligibility flow chart and its guidelines in collaboration with the MOHW and other implementing partners. GHSC-PSM continues to facilitate stakeholder engagement meetings and workshops to promote the benefits of MMD in antiretroviral drug (ARV) management and, as a result, how the supply chain continuum will respond to MMD implementation requirements.

Central Medical Stores together with GHSC-PSM has also modified the dispensary register to include MMD capturing and subsequent reporting by the facilities. This development in the dispensary register would help to know which MMD category is commonly used and what the implications are on supply chain management. GHSC-PSM also continues to support the MOHW with monitoring the MMD roll-out during the quarterly monitoring and support visits. Through this exercise, the MOHW can assess the progress made since MMD was adopted, as well as assess the facilities’ readiness for implementing the MMD, thus for those that have not yet started implementing it.