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Impact of Drug Stock-Outs on Death and Retention to Care among HIV-Infected Patients on Combination Antiretroviral Therapy in Abidjan, Côte d'Ivoire

Author

Listed:
  • Armelle Pasquet
  • Eugène Messou
  • Delphine Gabillard
  • Albert Minga
  • Ayeby Depoulosky
  • Sylvie Deuffic-Burban
  • Elena Losina
  • Kenneth A Freedberg
  • Christine Danel
  • Xavier Anglaret
  • Yazdan Yazdanpanah

Abstract

Background: To evaluate the type and frequency of antiretroviral drug stock-outs, and their impact on death and interruption in care among HIV-infected patients in Abidjan, Côte d'Ivoire. Methods and Findings: We conducted a cohort study of patients who initiated combination antiretroviral therapy (cART) in three adult HIV clinics between February 1, 2006 and June 1, 2007. Follow-up ended on February 1, 2008. The primary outcome was cART regimen modification, defined as at least one drug substitution, or discontinuation for at least one month due to drug stock-outs at the clinic pharmacy. The secondary outcome for patients who were on cART for at least six months was interruption in care, or death. A Cox regression model with time-dependent variables was used to assess the impact of antiretroviral drug stock-outs on interruption in care or death. Overall, 1,554 adults initiated cART and were followed for a mean of 13.2 months. During this time, 72 patients discontinued treatment and 98 modified their regimen because of drug stock-outs. Stock-outs involved nevirapine and fixed-dose combination zidovudine/lamivudine in 27% and 51% of cases. Of 1,554 patients, 839 (54%) initiated cART with fixed-dose stavudine/lamivudine/nevirapine and did not face stock-outs during the study period. Among the 975 patients who were on cART for at least six months, stock-out-related cART discontinuations increased the risk of interruption in care or death (adjusted hazard ratio [HR], 2.83; 95%CI, 1.25–6.44) but cART modifications did not (adjusted HR, 1.21; 95%CI, 0.46–3.16). Conclusions: cART stock-outs affected at least 11% of population on treatment. Treatment discontinuations due to stock-outs were frequent and doubled the risk of interruption in care or death. These stock-outs did not involve the most common first-line regimen. As access to cART continues to increase in sub-Saharan Africa, first-line regimens should be standardized to decrease the probability of drug stock-outs.

Suggested Citation

  • Armelle Pasquet & Eugène Messou & Delphine Gabillard & Albert Minga & Ayeby Depoulosky & Sylvie Deuffic-Burban & Elena Losina & Kenneth A Freedberg & Christine Danel & Xavier Anglaret & Yazdan Yazdanp, 2010. "Impact of Drug Stock-Outs on Death and Retention to Care among HIV-Infected Patients on Combination Antiretroviral Therapy in Abidjan, Côte d'Ivoire," PLOS ONE, Public Library of Science, vol. 5(10), pages 1-9, October.
    • Handle: RePEc:plo:pone00:0013414
    DOI: 10.1371/journal.pone.0013414
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    1. Josephine Walker & Betty B Chaar & Numa Vera & Alvish S Pillai & Jessy S Lim & Lisa Bero & Rebekah J Moles, 2017. "Medicine shortages in Fiji: A qualitative exploration of stakeholders’ views," PLOS ONE, Public Library of Science, vol. 12(6), pages 1-16, June.
    2. Fitzpatrick, Anne, 2022. "The impact of public health sector stockouts on private sector prices and access to healthcare: Evidence from the anti-malarial drug market," Journal of Health Economics, Elsevier, vol. 81(C).
    3. Ngai-Hang Z Leung & Ana Chen & Prashant Yadav & Jérémie Gallien, 2016. "The Impact of Inventory Management on Stock-Outs of Essential Drugs in Sub-Saharan Africa: Secondary Analysis of a Field Experiment in Zambia," PLOS ONE, Public Library of Science, vol. 11(5), pages 1-18, May.
    4. Wouters, Olivier J. & Sandberg, Dale M. & Pillay, Anban & Kanavos, Panos G., 2019. "The impact of pharmaceutical tendering on prices and market concentration in South Africa over a 14-year period," Social Science & Medicine, Elsevier, vol. 220(C), pages 362-370.
    5. Wouters, Olivier J. & Sandberg, Dale M. & Pillay, Anban & Kanavos, Panos, 2018. "The impact of pharmaceutical tendering on prices and market concentration in South Africa over a 14-year period," LSE Research Online Documents on Economics 90828, London School of Economics and Political Science, LSE Library.
    6. Varun Karamshetty & Harwin De Vries & Luk N. Van Wassenhove & Sarah Dewilde & Warnyta Minnaard & Dennis Ongarora & Kennedy Abuga & Prashant Yadav, 2022. "Inventory Management Practices in Private Healthcare Facilities in Nairobi County," Production and Operations Management, Production and Operations Management Society, vol. 31(2), pages 828-846, February.
    7. Cissy Kityo & Diana M Gibb & Charles F Gilks & Ruth L Goodall & Ivan Mambule & Pontiano Kaleebu & Deenan Pillay & Ronnie Kasirye & Peter Mugyenyi & A Sarah Walker & David T Dunn & on behalf of the DAR, 2014. "High Level of Viral Suppression and Low Switch Rate to Second-Line Antiretroviral Therapy among HIV-Infected Adult Patients Followed over Five Years: Retrospective Analysis of the DART Trial," PLOS ONE, Public Library of Science, vol. 9(3), pages 1-7, March.
    8. Bolajoko Jatau & Yohanna Avong & Olumide Ogundahunsi & Safieh Shah & Katherine Tayler Smith & Rafael Van den Bergh & Rony Zachariah & Johan van Griensven & Ernest Ekong & Patrick Dakum, 2015. "Procurement and Supply Management System for MDR-TB in Nigeria: Are the Early Warning Targets for Drug Stock Outs and Over Stock of Drugs Being Achieved?," PLOS ONE, Public Library of Science, vol. 10(6), pages 1-10, June.
    9. Tinne Gils & Claire Bossard & Kristien Verdonck & Philip Owiti & Ilse Casteels & Maria Mashako & Gilles Van Cutsem & Tom Ellman, 2018. "Stockouts of HIV commodities in public health facilities in Kinshasa: Barriers to end HIV," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-12, January.

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