electricsheepafrica/hiv-testkit-arv-supply

HIV Test Kit & ARV Supply Dataset

Abstract

This dataset provides 30,000 simulated facility-level observations (10,000 per scenario) of HIV commodity availability across three tiers of ART service delivery in sub-Saharan Africa. Each record represents one HIV commodity (ARVs, test kits, viral load reagents, OI prophylaxis) assessed at one facility during one quarterly period. The dataset captures 40+ variables spanning facility characteristics, commodity type, day-of-survey availability, stockout duration and causes, supply chain metrics, and patient impact including ART interruption, regimen substitution, and missed testing. Three scenarios model the HIV supply chain gradient: PEPFAR-supported urban ART clinic (89% availability), district hospital (65%), and rural health centre (30%).

This dataset is entirely simulated. It must not be used for clinical decisions or programme management.

1. Introduction

1.1 The HIV Commodity Supply Chain

Sub-Saharan Africa bears the largest HIV burden globally, with over 25 million people living with HIV and approximately 21 million on antiretroviral therapy (ART). Sustaining this treatment cascade requires an unbroken supply of ARV medicines, HIV rapid diagnostic test kits, viral load monitoring reagents, and opportunistic infection prophylaxis. The supply chain is predominantly funded by PEPFAR and the Global Fund, with USAID's Global Health Supply Chain Program (GHSC-PSM) serving as the primary procurement and distribution mechanism.

1.2 ARV Availability: Progress and Persistent Gaps

GHSC-PSM has delivered enough ARVs to provide over 20.5 million patient-years of treatment, including 79 million bottles of TLD (tenofovir/lamivudine/dolutegravir) — the WHO-recommended first-line regimen (GHSC-PSM, 2023). TLD availability at PEPFAR-supported sites increased from 84% to 100% between June 2020 and June 2021, and has remained between 98% and 100% since (GHSC-PSM, "Crisis to Confidence"). The Global Fund reduced TLD pricing to below $45 per patient per year through competitive tenders (Global Fund, 2023).

However, these achievements mask significant gaps. UNAIDS reported in 2025 that only 39% of reporting countries indicated low-to-minimal risk of ARV stockouts, meaning 61% face moderate-to-high risk — particularly countries dependent on donor funding transitions (UNAIDS, 2025). Pediatric ARV availability remains substantially lower than adult formulations, with nevirapine suspension and other pediatric formulations showing persistent shortages (GHSC-PSM; Nation Africa, 2024).

1.3 Test Kit and Reagent Supply

HIV rapid diagnostic test (RDT) kits and viral load reagents face distinct supply chain challenges. Test kit stockouts directly impede case finding — the entry point to the treatment cascade. In rural Mozambique, monitoring of pharmacy and test kit stocks across PEPFAR-supported facilities documented frequent stockouts in Zambézia Province, with rural facilities disproportionately affected (PMC, 2020; PMC7232670). Viral load reagent availability is particularly constrained at lower facility levels, where laboratory infrastructure is absent and sample referral networks are weak.

1.4 Patient Impact of Stockouts

ARV stockouts force treatment interruptions that undermine viral suppression, promote drug resistance, and increase mortality. Regimen substitutions — switching patients to available but suboptimal regimens — carry risks of adverse effects and reduced efficacy. Test kit stockouts mean undiagnosed infections continue to drive transmission. Viral load monitoring gaps mean treatment failure goes undetected.

1.5 Rationale

Despite extensive PEPFAR and Global Fund reporting, no open, standardised dataset integrates facility-level HIV commodity availability, stockout dynamics, supply chain metrics, and patient impact indicators. This dataset enables supply chain analysts and researchers to develop predictive models, benchmark facility performance, and model intervention strategies.

2. Methodology

2.1 Epidemiological Parameterization

Parameter	PEPFAR Urban	District Hospital	Rural HC	Source
ARV availability	92%	72%	45%	GHSC-PSM: 98-100% TLD at PEPFAR sites
Test kit availability	88%	65%	35%	PMC7232670: rural Mozambique
VL reagent availability	70%	35%	5%	Lab infrastructure constraints
Pediatric ARV availability	75%	50%	25%	GHSC-PSM: lower than adult
Stocked out in 6m	17%	54%	95%	UNAIDS: 61% countries moderate-high risk
Mean stockout days	5	15	31	Literature range
ART interruption rate	0.5%	5%	18%	Clinical impact data
Order fill rate	84%	60%	35%	GHSC-PSM end-use verification

2.2 HIV Commodity Selection

18 commodities across 8 categories reflecting the complete HIV supply chain:

Category	Commodities
ARV first-line	TLD (adult), TLE (adult)
ARV component	DTG 50mg
ARV second-line	ATV/r (adult)
ARV paediatric	LPV/r granules, Nevirapine suspension, ABC/3TC dispersible, DTG 10mg dispersible
ARV PMTCT	AZT syrup
Test kits	HIV RDT (screening), HIV RDT (confirmatory), HIV self-test
Lab reagents	Viral load cartridge, EID cartridge, CD4 cartridge
OI prophylaxis/TPT	Cotrimoxazole, Fluconazole, Isoniazid

2.3 Scenario Design

Scenario A — PEPFAR-Supported Urban ART Clinic: Electronic LMIS, dedicated HIV pharmacist, multi-month dispensing (MMD), direct GHSC-PSM supply, 3,000+ active patients. Analogous to high-volume ART sites in Kenya, Tanzania, Uganda, South Africa.

Scenario B — District Hospital ART Department: Paper LMIS, clinical officer managing ART, quarterly supply from district pharmacy, 800 active patients. Analogous to district ART sites in Malawi, Mozambique, Rwanda, Zambia.

Scenario C — Rural Health Centre ART: Nurse-led ART, no LMIS, irregular supply, limited test kits, no on-site viral load, 150 active patients. Analogous to primary ART sites in DRC, Niger, South Sudan, rural Mozambique.

3. Schema

3.1 Facility & Programme

Column	Type	Description
facility_level	categorical	urban_ART_clinic / district_hospital / rural_health_centre
pepfar_supported	binary	PEPFAR funding support
global_fund_supported	binary	Global Fund support
has_hiv_pharmacist	binary	Dedicated HIV pharmacist
lmis_type	categorical	electronic / paper / none
mmd_available	binary	Multi-month dispensing offered
art_patients_active	int	Active patients on ART
new_art_initiations_quarter	int	New initiations this quarter

3.2 Commodity

Column	Type	Description
commodity_name	categorical	18 HIV commodities
commodity_category	categorical	ARV / test_kit / lab_reagent / OI / TB_preventive
formulation	categorical	tablet_FDC / tablet / suspension / granules / rapid_test / self_test / reagent_cartridge
pepfar_funded_commodity	binary	Commodity procured via PEPFAR
unit_cost_usd	float	Approximate unit cost

3.3 Availability & Stockout

Column	Type	Description
available_on_survey_day	binary	Commodity present and usable
stocked_out_in_last_6m	binary	Any stockout in 6 months
stockout_days_last_6m	int	Total stockout days
stockout_episodes	int	Number of stockout episodes
stockout_cause	categorical	12 root cause categories

3.4 Supply Chain

Column	Type	Description
months_of_stock_on_hand	float	Current stock in months
last_resupply_days_ago	int	Days since last delivery
order_fill_rate_pct	float	Percentage of order fulfilled
emergency_order_placed	binary	Emergency order submitted

3.5 Patient Impact

Column	Type	Description
patients_turned_away	int	Patients turned away due to stockout
art_interruption_due_to_stockout	binary	ART treatment interrupted
regimen_substitution	binary	Switched to alternative regimen
testing_not_done_no_kits	binary	HIV testing not performed
viral_load_not_done	binary	VL monitoring skipped

3.6 Data Quality

Column	Type	Description
stock_card_up_to_date	binary	Stock records current
report_submitted_to_district	binary	Quarterly report submitted
report_timely	binary	Report on time

4. Validation

4.1 Key Validation Results

Metric	PEPFAR Urban	District	Rural	Literature
Availability	89%	65%	30%	98-100% PEPFAR [2]; gaps elsewhere [3]
Stocked out 6m	17%	54%	95%	61% countries at risk [3]
Stockout duration	5d	15d	31d	Literature range
ART interruption	0.5%	5%	18%	Clinical impact
Order fill rate	84%	60%	35%	GHSC-PSM data

5. Usage

from datasets import load_dataset

dataset = load_dataset(
    "electricsheepafrica/hiv-testkit-arv-supply",
    "district_hospital_art"
)
df = dataset["train"].to_pandas()

# Which commodities are most at risk?
risk = df.groupby('commodity_name').agg({
    'available_on_survey_day': 'mean',
    'art_interruption_due_to_stockout': 'mean'
}).sort_values('available_on_survey_day')
print(risk.head(10))

6. Limitations

• Simulated: Not from real PEPFAR or Global Fund supply chain data.
• No donor transition modelling: The dataset does not simulate the impact of PEPFAR funding changes.
• No drug resistance: ART interruptions do not model downstream resistance emergence.
• No longitudinal tracking: Records are cross-sectional, not patient-level treatment histories.
• Simplified costing: Unit costs are approximate global reference prices.

7. References

1. GHSC-PSM / USAID (2023). FY23 Q1 IDIQ Report. 20.5M patient-years ARV delivered.
2. GHSC-PSM. From Crisis to Confidence. TLD availability 98-100%.
3. UNAIDS (2025). HIV commodity availability fact sheet. 39% low risk; 61% moderate-high risk.
4. Global Fund (2023). TLD price reduced to <$45/year.
5. PMC (2020). Monitoring pharmacy and test kit stocks in rural Mozambique. PMC7232670.
6. Nation Africa (2024). Kenya among six countries on brink of running out of HIV drugs.

Citation

@dataset{esa_hiv_testkit_arv_2025,
  title   = {HIV Test Kit and ARV Supply Dataset: Commodity Availability,
             Stockouts, ART Interruption, and Patient Impact Across Three
             Tiers of ART Service Delivery in Sub-Saharan Africa},
  author  = {{Electric Sheep Africa}},
  year    = {2025},
  publisher = {Hugging Face},
  url     = {https://huggingface.co/datasets/electricsheepafrica/hiv-testkit-arv-supply},
  note    = {Simulated dataset. Not for clinical or programme decisions.}
}

License

CC-BY-4.0