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AIDS Res Hum Retroviruses. 2020 Jan 9. doi: 10.1089/AID.2019.0057. [Epub ahead of print]

Monitoring pharmacy and test kit stocks in rural Mozambique: U.S. PEPFAR Surveillance to help prevent Ministry of Health shortages.

Author information

Vanderbilt University Medical Center, 12328, Friends in Global Health, Quelimane, Mozambique;
Vanderbilt Institute for Global Health, Biostatistics, Nashville, Tennessee, United States;
Vanderbilt University Medical Center, 12328, Friends in Global Health, Quelimane, Mozambique;
Republica de Mocambique, 196547, Direcção Provincial de Saúde-Província da Zambézia, Ministério de Saúde, Quelimane, Mozambique;
Friends in Global Health (FGH), Maputo, Mozambique;
Vanderbilt University Vanderbilt Institute for Global Health, 228456, Nashville, Tennessee, United States;
Vanderbilt University Medical Center (VUMC), Department of Medicine, Division of Infectious Diseases , 1161 21st Avenue South, A-2200 Medical Center North (MCN), Nashville , Tennessee, United States, 37232.
Vanderbilt Institute for Global Health (VIGH), 2525 West End Avenue, Suite 750, Nashville , Tennessee, United States, 37203;
Yale University Yale School of Public Health, 50296, Dean's Office, P.O.Box 208034, New Haven, Connecticut, United States, 06520-8034;



Support of HIV and tuberculosis (TB) testing and treatment supported by PEPFAR in Africa requires immense quantities of tests and medications. We sought to use central pharmacy supply data of Mozambique's rural Zambézia Province (2017 population≈5.11 million persons; ≈12.6% adult HIV prevalence in 2016) to examine shortages, stockouts, and trends in availability.


Using stock surveillance for 60 weeks in 2014-2015, we assessed availability of 36 medications (four classes: adult antiretroviral medications (ARVs), pediatric ARVs, anti-TB medications, antibiotics) and diagnostic test kits (two rapid tests for HIV; one each for malaria and syphilis). We contrasted these to 2018-2019 data.


We modeled pharmacy data using ordinal logistic regression, characterizing weekly product availability in four categories: good, adequate, shortage, or complete stockout.


We found 166 (7.7%) stockouts and 150 (6.9%) shortages among 2,160 weekly records. Earlier calendar time was associated with reduced medication supplies (p<0.001). Certain medication/test kit classes were associated with reduced supply (p<0.001). We found an interaction between time and medication class on the odds of reduced supply (p<0.001). Pediatric ARVs had a 17.4 (95%CI: 8.8-34.4) times higher odds of reduced medication supply compared with adult ARVs at study mid-point. Trends comparing the first and last weeks showed adult ARVs having 67% and pediatric having 71% lower odds of reduced supplies. Only adult ARVs shortages improved amid growing demand. Data from 2018-2019 suggest continuing inventory management challenges.


Monitoring of drug (especially pediatric) and test kit shortages is vital to ensure quality improvement to guarantee adequate supplies to enable patients and care providers to achieve sustained viral suppression. A central Mozambican drug repository in the nation's second largest Province continues to experience drug and rapid test kit stockouts.


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