Drug supply at STI care services
Export Indicator
Correct history-taking, diagnosis and prescription are all very well, but if drugs are not available these will not translate into cases cured and will therefore have no positive impact on the likelihood of HIV infection. National AIDS programmes engaged in improving STI services have put time and money into improving drug distribution services and in attempting to ensure adequate manufacturing or importing of drugs for the syndromic management of STIs. This indicator measures the extent to which those efforts have been successful in ensuring that service providers are consistently supplied with the drugs they need to work efficiently.
Number of clients attending facilities providing STI services that have adequate drugs currently in stock to treat each of the importnant STI syndromes and that report no stock outs of these drugs lasting more than one week in the past 12 months
Total number of clients attending all STI service facilities surveyed
Countries promoting syndromic management of STIs usually have protocols for the prescriptions of drugs by syndrome. These are backed up by the inclusion of the relevant drugs on the nations essential drug list. Drugs necessary to treat each of the important syndromes should be included in the stock-check for this indicator. A survey of randomly selected facilities providing STI services checks for current supplies of designated drugs. Clinic management is questioned about stockouts in the last 12 months, and clinic stock records are reviewed for that period. Client numbers are also recorded. The sampling frame for the selection of sites may include private clinics and hospitals and non-government services, as well as public facilities. In constructing the indicator, each facility is weighted by its client load. This is because a rupture of stock at a small rural clinic will have less impact on the epidemic at a national level than a stockout in a large urban clinic that sees many times more patients. The indicator is the total number of clients attending facilities providing STI services that have adequate drugs currently in stock to treat each of the important STI syndromes and that report no stockouts of these drugs lasting more than one week in the past 12 months, divided by the total number of clients attending all STI service facilities surveyed. Depending on national policy, it is possible to include a variety of outlets providing services for HIV care in this indicator. This may include integrated reproductive health services, private sector facilities, and pharmacies with special training in STI care provision.
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This is a good measure of consistent supplies of drugs to STI service facilities; it provides a minimum measure of the availability of drugs. It is recognised, however, that clients very often buy drugs from other sources, even when they have been to an STI facility for diagnosis. Indeed, in countries where control of drug supplies are lax, a stockout in a public clinic may simply mean that the supply of drugs has been diverted to another nearby outlet. This is likely to affect the cost of the drug to the client (and therefore accessibility), but it may not affect the physical availability of the drug. Again, the selection of STI facilities may have a major influence on the indicator. The facility survey should attempt to include a mix of all major provider categories in both the public and the private sectors.