ABSTRACT
BACKGROUND: Health supply chain is crucial for proper functioning of a health system and advancing national and international health security goals. The Coronavirus 2019 pandemic caused major challenges for health supply chain systems in Uganda and globally. OBJECTIVES: This study involved literature review to examine how the electronic logistics management information system and related digital systems were harnessed be best support public health emergencies. METHODS: We describe how the health supply chain system leveraged the emergency Electronic Logistic Management Information System developed during the Ebola epidemic in 2019 to support the COVID-19 response in Uganda. The findings are based on the analysis of reports, guidelines, and discussions with stakeholders involved in implementing the electronic Management Information System during the COVID-19 response. Lessons and experiences are shared on how the system supported data visibility, use and health commodity management. RESULTS: A web-based emergency Electronic Management Information System was developed to support the supply chain system during preparedness and response to the Ebola Virus. The system facilitated coordination, information management and provided real-time data for planning, decision making, and distribution of commodities during the COVID-19 response. To address any human resource challenges, 863 staff were trained and mentored in the use of the system. The system enabled the Ministry of Health to track the distribution of Medical Counter Measures through the warehouses, eight regional pre-positioning centers, and over 2000 user units in 136 district vaccine stores. In addition, the system provided quality data for the quantification and monitoring of commodities at all levels of care. Over 1800 bulk orders were processed through the system. Real time stock status reports were transmitted from all national, regional, district and health facility levels. Procurement tracking reports, stock gap analysis and partner contribution were all accessible and visible in the system. This supported the Ministry of Health's resource mobilization and coordination efforts. CONCLUSIONS: Availability of reliable, quality real-time data are essential for effective decision making during public health emergencies. The emergency Electronic Logistic Management Information Systems supported health authorities to mount coordinated and effective responses to ensure timely availability of commodities and supplies to support the COVID-19 pandemic response. Lessons learnt from the Ebola epidemic response were translated into actions that enabled effective preparedness and response to the COVID-19 pandemic.
ABSTRACT
BACKGROUND: In low income countries such as Uganda progress has been made towards achieving the United Nations AIDS programme 95-95-95 target however efforts are still impeded by pretreatment drug resistance and adverse drug events (ADEs) hence introduction of dolutegravir-based antiretroviral therapy as first-line treatment due to a higher genetic barrier to resistance, better tolerability and safety profile. However, recent studies have raised concerns regarding its safety in real-clinical settings due to ADEs and being a recently introduced drug there is need to actively monitor for ADEs, hence this study aimed to establish the prevalence and factors associated with ADEs among patients on dolutegravir-based regimen at the Immune Suppression Syndrome (ISS) Clinic- Mbarara Regional Referral Hospital (MRRH). METHODS: A mixed design study was conducted at ISS Clinic-MRRH among 375 randomly selected patients who had been exposed to DTG-based regimen for at-least 12 weeks. These were interviewed to obtain data on socio-demographics, dietary habits and their files reviewed for ADEs. Data entry was done using Epi-data 3.0 and exported to SPSS 25.0 for analysis. Prevalence was determined as a percentage, and ADE associated factors assessed using bivariate analysis, those found significant were further subjected to multivariate analysis and considered significant at P < 0.05. RESULTS: The prevalence of ADEs among patients on DTG-based regimen was found to be 33.1% (124/375) with 5.6% (7/124) participants discontinued from treatment due ADEs, 4 due to hyperglycemia and 3 liver toxicity. The commonly experienced ADE was allergy at 36.3%. Male sex (AOR 1.571, 95% CI 1.433-1.984), WHO stage one at entry to care (AOR 4.586, 95% CI 1.649-12.754), stage two (AOR 4.536, 95% CI 1.611-12.776), stage three (AOR 3.638, 95% CI 1.262-10.488), were significantly associated with ADEs. Patients with undetectable viral load at initiation of DTG-based regimen were 67.6% less likely to experience ADEs (AOR = 0.324, 95% CI 0.1167-0.629). CONCLUSION: This study reports a prevalence of 33.1% of ADEs among patients on DTG-based regimen. The most commonly experienced ADE was allergy. Male sex, early HIV disease stage at entry into care and detectable viral load at initiation of DTG-based regimen were significantly associated with ADEs. It is crucial to actively monitor patients with these characteristics for ADEs.
