Supply Chain Management of Antiretroviral Drugs in Public Health Facilities in Borno State

Uninterrupted antiretroviral drug (ARV) supply is essential to sustaining virological suppression in people living with HIV and preventing the emergence of drug resistance. In Borno State, North East Nigeria, where ongoing humanitarian crises have disrupted health supply chains, ART drug availability represents a critical programmatic vulnerability. This study evaluates the supply chain management of antiretroviral drugs at public ART-dispensing facilities in Borno State. A facility-based cross-sectional assessment will be conducted at 18 ART sites across Maiduguri, Jere, and Gwoza local government areas. Assessment domains will include stock availability at the time of survey, frequency of stockouts in the preceding 12 months, consumption rate accuracy, drug ordering and procurement cycle compliance, storage condition adequacy, and cold chain requirements for specific ARV formulations. Pharmacist and store keeper interviews will assess supply chain management competencies. A parallel review of the National Pharmaceutical Supply Agency's distribution records for Borno State will provide secondary data on supply chain performance. Studies from conflict-affected Nigerian states reveal ARV stockout rates of 20 to 50 percent, with direct clinical consequences for patient adherence. Findings will identify critical supply chain vulnerabilities in Borno State and recommend interventions for the NPHCDA and PEPFAR implementing partners to strengthen ARV supply resilience in humanitarian settings. Keywords: antiretroviral drugs, supply chain, ART, Borno State, stockouts