Person-centered Supply Chains for HIV Care: Uganda Scales Up Community Retail Pharmacy Drug Distribution Points

People who have HIV must have access to care and support to adhere to treatment, which greatly reduces morbidity and mortality and prevents transmission to others. However, there are myriad individual and societal barriers to antiretroviral therapy (ART) services. The former include living far from health facilities, so having to spend time and money to get drug refills; long wait times at facilities; and fear that one’s confidentiality will not be maintained. The latter include poverty, lack of information, and HIV-related stigma and discrimination.

As part of its effort to improve access to and quality of HIV prevention, testing, and treatment services, USAID’s Regional Health Integration to Enhance Services-North, Lango (RHITES-N, Lango) project, in conjunction with the Ministry of Health (MOH), implemented the community retail pharmacy drug distribution point (CRPDDP) model in Uganda’s Lango Sub-region.

After identifying and assessing six private pharmacies, RHITES-N, Lango project selected three pharmacies associated with Lira Regional Referral Hospital (Lira RRH) and one associated with Apac General Hospital to provide ART refills for people living with HIV. These model pharmacies offer people who live far from the hospitals a more convenient place to refill prescriptions. The project helped the pharmacies create client demand for their services through community sensitization and mobilization and health education sessions. The project’s social and behavior change communication team oriented community leaders living with HIV to the model, and facility staff contacted eligible clients, got their consent, and initiated ART refills at the pharmacy of their choice.

We had challenges in offering quality services because of the high number of clients, poor retention because of the long waiting time and distance, poor viral load suppression due to lost to follow up and missed appointment but with the [new] model, there’s a reduction in the number of clients hence shorter waiting time.” Felix Oroc, nurse at Lira RRH ART clinic.

The project continues to work with MOH, local partners, districts, and health facilities to conduct capacity building and support supervision visits to the selected hospitals and their associated model pharmacies; provide information and communication technology support to the data management teams; and track CRPDDP model implementation progress.

The graph below indicates the total number of clients who received ART refills from the model pharmacies from December 2021 to September 2022. By the end of September 2022, more than 4,400 clients had been enrolled on the model.

The RHITES-N, Lango project and local USAID-funded partners, including Kigezi/Lango, and district officials are working on a detailed transition plan to ensure continuity of HIV services, with a focus of sustaining the project’s and other interventions. This includes meetings to discuss the CRPDDP model uptake, best practices, challenges, lessons, next steps, and the model’s role in ensuring access to convenient HIV services.