The development of the HIV antiretroviral drug delivery system in Thailand

Abstract

Since 2001, Department of Disease Control (DDC) in Thailand, under the Ministry of Public Health, has been instrumental in developing and implementing the National Program for People Living with HIV/AIDS (NAPHA) which offers free treatment services nationwide for individuals living with HIV/AIDS (PLHIV), providing access to antiretroviral drugs, laboratory supplies, and equipment to hospitals until the program reaches maturity and stability. Initially, the Department of Disease Control managed the procurement and distribution of medications, directing them to the warehouses of the Office of Disease Prevention and Control (ODPC) regions 1 - 12 and the Bangkok Metropolitan Administration (BMA). ODPC then delivered ARV drugs to hospitals in their regions, while BMA also delivered ARV drugs to hospitals in Bangkok. Due to the increasing number of PLHIV requiring lifelong medication and services, there has been a growing burden on both central and regional medication distributors. To address this issue, a parallel HIV antiviral drug management system was developed to streamline the procurement and distribution processes. This involved partnering with Government Pharmaceutical Organization (GPO) to implement a vendor managed inventory (VMI) system, a first-of-its-kind initiative in Thailand. Under this system, the GPO manages inventory directly and delivers medications to hospitals. The VMI approach was initially implemented with HIV antiviral drugs as a pilot before extending to other types of medications. Hospitals report the quantity of medications entering the VMI system online every month. When the medication level reaches the agreed minimum threshold, the Government Pharmaceutical Organization replenishes the medication to the agreed-upon safe level within 7 business days. Medications distributed/imported from foreign pharmaceutical companies are managed centrally and then distributed to regions and hospitals. The simultaneous use of both systems of HIV antiviral drug management complements each other to ensure that Thailand's HIV antiviral drug management system delivers medications to hospitals consistently, providing uninterrupted treatment to PLHIV.