Assessment of the Pharmaceutical Supply Chain for Antiretroviral Drugs at Secondary Hospitals in Delta State, South South Nigeria

Consistent access to antiretroviral therapy is critical to achieving viral suppression and preventing HIV transmission among persons living with HIV. Supply chain inefficiencies, including stockouts and expiry losses, remain major threats to antiretroviral therapy program outcomes in Nigerian hospitals. This study assessed the pharmaceutical supply chain for antiretroviral drugs at secondary-level hospitals in Delta State, South South Nigeria. A cross-sectional mixed-methods design was employed, involving 10 hospitals participating in the state's antiretroviral therapy program. Pharmacists, pharmacy technicians, and store managers were interviewed, and inventory records were reviewed for a 12-month period. Key metrics assessed included order cycle time, stock-out frequency, expiry rates, and cold chain compliance. Stockouts lasting more than five days were reported in seven of ten hospitals within the review period, with an average annual stock-out frequency of 4.6 episodes per site. Expired antiretroviral medicines accounted for 3.2 percent of inventory value. Cold chain infrastructure was inadequate in three hospitals. Ordering delays and inconsistent quantification by procurement officers were key contributory factors. The findings highlight urgent gaps in supply chain management that threaten program continuity. Recommendations include adoption of real-time inventory tracking systems, pharmacist engagement in quantification exercises, and strengthening of the state-level supply chain oversight structures. Keywords: antiretroviral drugs, pharmaceutical supply chain, Delta State, HIV program, stockout