ZIMBABWE’S DELIVERY
TEAM TOPPING UP
SYSTEM: ADDING HIV
TESTS AND NEVIRAPINE
FOR PMTCT
David Alt, Country Director
Naomi Printz, Technical Advisor
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
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PEPFAR
Implementing Partner
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)
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Implementing Partner
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
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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
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Implementing Partner
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
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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)
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PEPFAR
Implementing Partner
Delivery Coverage – Mash. Central
Delivery
Run
Total
Facilities
Received
Deliveries
% Delivery
Coverage
1
66
66
100
2
87
86
99
3
87
66
75
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Implementing Partner
Delivery Coverage – Mat South
Delivery
Run
Total
Facilities
Received
Deliveries
% Delivery
Coverage
1
52
52
100
2
54
50
93
3
56
52
93
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Implementing Partner
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
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Reasons facility missed
• Heaviest rainy season  flooded rivers
• Drug rooms locked
• Nurse away
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Stock Out Rates - Mash Central
Product
Run 1
Run 2
Run 3
Chase Buffer
33
37
2
Determine
11
5
2
SD Bioline
19
5
2
Oraquick
77
83
100
Infant Nev.
39
9
2
Matern. Nev
33
15
2
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Implementing Partner
Stock Out rates – Mash Central
40
35
30
Chase Buffer
25
Determine
20
SD Bioline
Infant Nevirapine
15
Maternal Nevirapine
10
5
0
Run1
Run2
Run3
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PEPFAR
Implementing Partner
Stock Out Rates Mat. South
Product
Run 1
Run 2
Run 3
Chase Buffer
65
25
16
Determine
0
4
6
SD Bioline
3
4
6
Oraquick
68
100
100
Infant Nev.
39
2
2
Matern. Nev
39
2
2
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PEPFAR
Implementing Partner
Stock Out Rates: Mat South
70
60
50
Chase Buffer
40
Determine
SD Bioline
30
Infant Nevirapine
20
Maternal Nevirapine
10
0
Run1
Run2
Run3
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PEPFAR
Implementing Partner
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
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Implementing Partner
Uptake of Maternal and Infant NVP Prophylaxis
Percentage Women and Infants Dispensed with sdNVP
12 Sites from Matabeleland South Jan-Dec 2007
% Women Dispensed w ith sdNVP
% Infants Dispensed sdNVP
100%
88%
82%
83%
80%
66%
60%
66%
55%
61%
55%
40%
20%
0%
Jan - Mar
Apr - Jun
Jul - Sep
Oct - Dec
Quarter - 2007
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Implementing Partner
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
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PEPFAR
Implementing Partner
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.
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Implementing Partner
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
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Implementing Partner
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
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Implementing Partner
Mazviita, Siyabonga,
Thank you!
Questions?????
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