Transforming supply chains to fight HIV: PFSCM’s impact

by Marloes Dijkema-boyd | Nov 28, 2023

December 1st marks the annual celebration of World AIDS Day, a day to reflect on the progress made in the fight against HIV/AIDS. In countries where the Global Fund to Fight AIDS, Tuberculosis, and Malaria invests, AIDS-related deaths have fallen by 72% since 2002, and new HIV infections have gone down by 61%.

Despite the progress made in the last year, with 1.3 million new infections in 2022, it is clear that more work is needed. Today, we recognize the strong commitment of organizations worldwide who work tirelessly to improve accessibility to life-saving HIV products globally.

The Partnership for Supply Chain Management (PFSCM) has been committed to optimizing supply chains to enhance access to HIV and other health products since our inception more than a decade ago.

In the last few years alone*, PFSCM has served clients in 90 countries, facilitating transactions of more than $538 million in HIV products and delivering 4,954 shipments worldwide.

*Data: Jan 1, 2020 to Oct 31, 2023.

Visibility for efficient supply chains and safe products

Over the years, we’ve learned that “what gets measured gets done.” This means that we must collect, analyze, and disseminate data to gain a detailed understanding of the HIV epidemic. This understanding helps us to reach the right people in the right place and at the right time.

PFSCM uses end-to-end supply chain data, from product information to shipping milestones, to connect supply chain stakeholders. Increasing visibility in the supply chain not only ensures HIV products are delivered on time but also guarantees the quality and safety of products.

PFSCM uses data loggers to monitor and capture valuable information about the temperature and humidity time and temperature HIV products like Viral Load reagents are exposed to during transportation and storage without opening the boxes. By monitoring during transit, we can mitigate risk and take necessary measures to ensure the quality and safety of the delivered products.

Read more about how the collaborative use of data drives positive change in global health supply chain, and learn more about how digitization can help overcome supply chain disruptions.

Improving access to life-saving HIV products by transforming the supply chain

Accessibility to HIV services and supplies in low- and middle-income countries (LMICs) remains a significant challenge. More than 90% of the volumes managed by PFSCM are intended for African nations, where HIV/AIDS continues to be a major global health issue that requires sustained commitment.

The COVID-19 pandemic has highlighted the vulnerabilities of global supply chains. Long supply chains can cause delays in the delivery of essential life-saving products and can be particularly problematic during emergencies such as pandemics. Long supply chains are also more susceptible to disruptions in transportation and logistics, which can further delay the delivery of products. On the other hand, short supply chains, which involve local production, can help improve the timely delivery of life-saving products to communities. However, the local production of pharmaceuticals and medical products in Africa is faced with several challenges, including inadequate infrastructure, insufficient funding, and a lack of technical expertise.

Although progress has been made in strengthening local production of medicines and promoting technology transfer, challenges persist, and new ones have emerged.

The global development community is focusing on three main areas to strengthen supply chains: enabling local production, encouraging localization, and supporting technology transfer. These strategies aim to reduce risks, costs, and waste while increasing the resilience and self-reliance of stakeholders in LMICs. Through initiatives such as prequalification, vendor-managed inventory, and community engagement, stakeholders can improve the reliability and affordability of health products, uplift local suppliers, and stimulate local economies.

According to the World Health Organization (WHO), Africa’s population is expected to reach 2.5 billion by 2050, but most African countries have less than five manufacturers on average. Local sourcing is an essential procurement strategy for PFSCM. It helps to build strong relationships with suppliers, ensuring both the affordability and quality of HIV products. However, this is extremely challenging to achieve, particularly in sub-Saharan Africa, which heavily relies on imported health products and diagnostics. The price competitiveness of locally supplied or produced health products is adversely affected by several factors: fragmented wholesaler and distributor landscape, weak regulatory systems, and poor accessibility impact the price competitiveness of locally supplied or produced health products.

PFSCM works closely with manufacturers to better understand their global footprint, pricing structures, and the availability and shelf life of their products in-country. We help connect countries and global suppliers and negotiate affordable long-term pricing structures, developing sustainable procurement and delivery mechanisms that benefit health programs.

Recently, a new initiative called the Health Products Manufacturing Support Platform was launched during the World Local Production Forum by Unitaid, African Union Development Agency-NEPAD, and WHO. This is a significant step towards improving health technologies in Africa and an important milestone in the region’s drive to produce quality-assured health products.

Additionally, there are several initiatives in the market now related to developing local supply. Diversifying health product manufacturing geographically will enhance local and regional production capacity, allowing for better global health outcomes and equitable access to essential health products.

Meanwhile, the theme for this year’s World AIDS Day is “Let Communities Lead,” highlighting the importance of empowering communities to take ownership of their own health and to lead and drive initiatives like local production for the betterment of supply chains.

It is through community-led programs, investments, and initiatives that the sustainability of HIV programs can be ensured. As we commemorate World AIDS Day, we renew our commitment to helping countries end inequalities, HIV/AIDS, and epidemics by creating stronger supply chains.

Navigating the changing CD4 landscape to ensure HIV diagnostic service continuity

Over the last couple of years, the CD4 diagnostic landscape has been changing, and key testing platforms are being discontinued. This supply chain will make it more complicated for countries to secure CD4 stock and may affect health services delivery if stakeholders do not monitor the situation and adapt accordingly. This is a supply chain scenario for which PFSCM has been preparing to ensure that we can continue to support our clients with alternative testing products and offer them the best advice for managing risk so that they can continue to serve the millions living with HIV and advanced HID disease (AHD).

Learn more about what CD4 testing is, what production and supply changes are occurring in the market, and what supply chain stakeholders, specifically procurers/buyers, can do to minimize supply disruption and, ultimately, ensure service continuity.

Supporting diverse clients with supply chain solutions for HIV programs

A deep commitment to helping children, adolescents, and young adults in sub-Saharan Africa access appropriate HIV treatment

PFSCM has served the Janssen Pharmaceutical Companies of Johnson & Johnson’s New Horizons Collaborative since 2014. The New Horizons Collaborative project is a collaborative initiative that is working to build awareness, inspire action, advance learning, and implement change to address the unmet needs of HIV treatment-experienced children, adolescents, and young adults in sub-Saharan Africa. PFSCM is responsible for forecasting, validation, coordination, and order placement activities to ensure donated pediatric HIV medicines such as Janssen Therapeutics’ Prezista and Intelence products reached recipients in Cameroon, Eswatini, Kenya, Lesotho, Nigeria, Rwanda, Uganda, Zambia, and Zimbabwe on time and in full with their integrity intact. Since 2014, PFSCM has delivered $114 million worth of donated pediatric HIV products to all nine New Horizons Collaborative countries on behalf of Janssen. In 2021, PFSCM joined Janssen’s stakeholders in recommitting to the program’s second phase, by incorporating a Monitoring & Evaluation (M&E) initiative to maximize the program’s impact. PFSCM provided on-the-ground supply chain Monitoring and Evaluation (M&E) work for the New Horizons Collaborative countries in Kenya, Zambia, and Nigeria in conjunction with JSI and InSupply. The M&E initiative assessed and measured in-country supply chain processes, systems, and performances and collected data to identify performance gaps. To conclude the second phase of the program and contribute to its success, PFSCM assisted countries in setting appropriate performance targets and made recommendations for improvements that enabled countries to meet and exceed targets.

Helping countries in Eastern Europe and Central Asia deliver on their niche research-based HIV projects

PFSCM assisted UNAIDS Eastern Europe and Central Asia (EECA) in identifying and contracting an affordable and reliable supplier of quality HIV recency tests for its research-only HIV recency testing programme, and managing the logistics for delivering the goods from the supplier to in-country destinations in six countries. The incorporation of HIV recency testing (detection of HIV infection in less than six months) in national HIV case reporting systems, will help to assess how HIV is being transmitted, describe behaviors that are facilitating HIV transmission, and optimize HIV-related data collection and information on risk factors. In 2019, when PFSCM first started supporting UNAIDS EECA, there were very few suppliers of recency tests, and a limited number could offer value-added services like the training needed to support laboratory and research staff in using and analyzing the unique recency tests. PFSCM navigated the fairly niche HIV recency testing market and identified two appropriate suppliers to support UNAIDS. PFSCM helped UNAIDS secure a contract with the supplier, who not only offered the best-priced and best-quality products but also included essential training in their pricing structure. The training offered by the supplier is critical in ensuring relevancy tests are implemented correctly. PFSCM facilitated the direct contracting processes between UNAIDS and one US-based supplier and managed the intricate cold chain shipments from the US to Armenia, Belarus, Kyrgyzstan, Tajikistan, and Uzbekistan.

A longstanding partnership to improve access to HIV products in the Dominican Republic

PFSCM has served the Ministry of Health (MoH) of the Dominican Republic (DR) as a trusted PSA partner for more than 10 years. Through our partnership with the DR, PFSCM has helped the country to access and maintain a reliable supply of affordable quality-assured antiretrovirals (ARVs), HIV rapid diagnostic test kits, viral load reagents, and condoms for its HIV programs. It was through these programs that PFSCM was able to provide the DR with technical assistance (TA) and in-country logistics services, which helped the MoH improve its downstream distribution and plan for and adopt a multi-month dispensing (MMD) of ARVs for patients meeting the treatment criteria. Since 2018, PFSCM has delivered HIV products valued at more than $42 million to the Dominican Republic. Through best procurement practices, TA, in-country logistics, MMD, and carton-less packaging initiatives, PFSCM saved the MoH of the DR over millions in procurement costs over the last decade. PFSCM continues to support the country with global access pricing for ARVs and diagnostics. Thus achieving better coverage of ARV treatment and continuity in diagnostics services.

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