Issues: In September 2018, MoH Uganda adopted Dolutegravir (DTG)-based regimens including Tenofovir/Lamivudine/Dolutegravir (TLD) to improve HIV treatment outcomes for eligible patients. A national transition plan was developed to phase in new and phase out legacy ARVs. However, product transitions if not managed well pose a risk of stock outs and wastage through expiries of new and legacy ARVs respectively. We describe Medical Access experience during the roll out of DTG based regimens at PEPFAR/CDC supported health facilities in Uganda.

Description: Orders of new products were obtained from the supply plan and placed with the only two US-FDA approved suppliers for TLD 6 months prior to the transition start date (October 2018). Stock was received in the country 3 months before the transition start date. Product introduction at the health facilities was done in a phased manner with orders adjusted using an order conversion tool that computed the amount of new and legacy ARVs to supply based on patient numbers and the transition rates. Stock availability at the central warehouse and health facilities and patient enrollment numbers were monitored monthly.

Lessons Learned: During the first four months (from October 2018) 54% of 115,012 targeted patients were transitioned to the new optimized regimens and the target was achieved by October 2019 with zero stock outs of TLD. A reduction in consumption of legacy regimens was observed by December 2019: Efavirenz-600mg (76%), Nevirapine-200mg (87%), Zidovudine/Lamivudine/Nevirapine-300mg/150mg/200mg (84%).

Recommendations: Good supply planning and monitoring of product transition processes are key in ensuring successful product introduction.