1. ZIMBABWE’S DELIVERY TEAM TOPPING UP SYSTEM: ADDING HIV TESTS AND NEVIRAPINE FOR PMTCT David Alt, Country Director Naomi Printz, Technical Advisor

2. PEPFAR Implementing Partner 2 Background for DTTU Started in late 2003 as the logistics system for condoms and contraceptives Run by Zimbabwe National Family Planning Council Funded by USAID through USAID | DELIVER PROJECT and DfID through Crown Agents Forced ordering delivery truck inventory control system Delivery truck loaded with commodities drives to all facilities (1600+ total) once in 4 months Facilities do not place orders

3. PEPFAR Implementing Partner 3 How a DTTU delivery works Delivery team arrives at facility and: Questions SDP staff about losses and adjustments and days out of stock Carries out physical counts of commodities Calculates the average monthly consumption Calculates maximum quantity for the facility Tops up the facility to maximum quantity level Facility Staff sign for the stock delivered All calculations and receipts recorded on Delivery/Receipt Voucher (DRV)

4. PEPFAR Implementing Partner 4 DTTU Achievements 97% Coverage (3% facilities not delivered to) More than 95% availability for condoms and contraceptives Reliable Logistics Management Information System (LMIS) with data on stock on hand, consumption, and losses & adjustments

5. PEPFAR Implementing Partner 5 Background to HIV test kit and NVP management Managed under the AIDS & TB Unit of the Ministry of Health and Child Welfare No national logistics data available  reporting rates less than 30% No delivery system in place  sites had to travel to central warehouse to collect stocks Reports of stockouts and overstocks HIV test kits and NVP for PMTCT are FULL SUPPLY commodities

6. PEPFAR Implementing Partner 6 Pilot for Adding HIV RTKS & NVP to DTTU MOHCW AND ZNFPC decided to pilot the addition of HIV RTKs and NVP- Jul to Dec 2007 In 2 provinces: Matebeleland South and Mashonaland Central

7. PEPFAR Implementing Partner 7 Objectives of the pilot To determine whether including HIV tests and NVP into DTTU would: 1.Make HIV RTKs and NVP widely available 2.Improve reporting rates for RTKs and NVP (Create a reliable LMIS)

8. PEPFAR Implementing Partner 8 Delivery Coverage – Mash. Central Delivery Run Total Facilities Received Deliveries % Delivery Coverage 166 100 2878699 3876675

9. PEPFAR Implementing Partner 9 Delivery Coverage – Mat South Delivery Run Total Facilities Received Deliveries % Delivery Coverage 152 100 2545093 3565293

10. PEPFAR Implementing Partner 10 Delivery coverage – new facilities Total of 30 new facilities in Mash Central Total of 25 new facilities in Mat South 38% of total coverage = new facilities

11. PEPFAR Implementing Partner 11 Reasons facility missed Heaviest rainy season  flooded rivers Drug rooms locked Nurse away

12. PEPFAR Implementing Partner 12 Stock Out Rates - Mash Central ProductRun 1Run 2Run 3 Chase Buffer33372 Determine1152 SD Bioline1952 Oraquick7783100 Infant Nev.3992 Matern. Nev33152

13. PEPFAR Implementing Partner 13 Stock Out rates – Mash Central

14. PEPFAR Implementing Partner 14 Stock Out Rates Mat. South ProductRun 1Run 2Run 3 Chase Buffer652516 Determine046 SD Bioline346 Oraquick68100 Infant Nev.3922 Matern. Nev3922

15. PEPFAR Implementing Partner 15 Stock Out Rates: Mat South

16. PEPFAR Implementing Partner 16 Linking logistics data and service statistics Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) supporting PMTCT activities in Zimbabwe In conjunction with EGPAF, wanted to determine whether improved commodity availability led to an increase in clients served

17. PEPFAR Implementing Partner 17 Uptake of Maternal and Infant NVP Prophylaxis

18. PEPFAR Implementing Partner 18 Issues highlighted in the pilot Chase buffer use & unit of recording Shelf Life of Oraquick  new tiebreaker has been identified Packaging of nevirapine syrup New PMTCT regimens

19. PEPFAR Implementing Partner 19 Results of the pilot 1.Rapid test kits and PMTCT NVP now widely available in the 2 provinces. 2.LMIS in the 2 provinces captures essential logistics data. 3.Reporting rate in the 2 provinces improved from 30% to 97% after only 3 deliveries. It was recommended that HIV test kits and NVP to be added to the DTTU system and rolled out nationally as soon as possible.

20. PEPFAR Implementing Partner 20 Changes made to DTTU Number of commodities increased from 5 to 11 Deliveries were changed from every 4 months to every 2 months Maximum stock reduced from 8 months to 4 months Standard operating procedures developed (along with new forms) All team leaders trained

21. PEPFAR Implementing Partner 21 Now…. Integrated deliveries are being incrementally implemented throughout the country By end July, every facility in the country will be receiving integrated deliveries Pilot to automate the completion of the Delivery/Receipt Voucher has been started

22. PEPFAR Implementing Partner 22 Mazviita, Siyabonga, Thank you! Questions?????