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Drug stock-outs in HIV, tuberculosis, and malaria programs: a systematic review
Avaneesh Kumar Pandey1, Ritika Kondel Bhandari1, Esmita Charani2,3
1Clinical Pharmacology Unit, Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Eclinicalmedicine
|August 9, 2026
Summary
Stock-outs of essential medicines for HIV, tuberculosis, and malaria in LMICs are preventable. Strengthening supply chains with better forecasting, logistics, and financing is key to ensuring medicine availability.
Area of Science:
- Global Health
- Health Systems Strengthening
- Pharmaceutical Supply Chain Management
Background:
- Essential medicines for HIV, tuberculosis, and malaria are frequently unavailable in low- and middle-income countries (LMICs).
- These stock-outs significantly impact health systems and patient health outcomes.
- This review synthesizes evidence on the causes, consequences, and mitigation strategies for these critical medicine shortages.
Purpose of the Study:
- To systematically review and synthesize evidence on the causes, consequences, and mitigation strategies for stock-outs of antiretroviral, anti-tuberculosis, and anti-malarial medicines.
- To identify key factors contributing to medicine stock-outs in LMICs.
- To evaluate strategies for preventing and mitigating these stock-outs.
Main Methods:
- A systematic search of major databases (PubMed, Embase, Web of Science, Scopus) was performed for studies published between January 2000 and March 2026.
- Studies focusing on stock-outs of antiretroviral, anti-tuberculosis, or anti-malarial medicines were included.
- Findings were synthesized qualitatively, and study quality was assessed using the Joanna Briggs Institute critical appraisal checklist.
Main Results:
- Fifty-six studies were included, revealing that supply chain inefficiencies, procurement delays, funding gaps, weak governance, and poor demand forecasting are primary causes of stock-outs.
- Consequences include treatment interruptions, increased drug resistance, higher morbidity and mortality, and increased patient out-of-pocket expenses.
- Mitigation strategies encompass emergency purchasing, redistribution, improved procurement, buffer stocks, supplier diversification, and digital inventory management.
Conclusions:
- The causes of medicine stock-outs in HIV, tuberculosis, and malaria programs are largely preventable.
- Fortifying supply chain systems through enhanced forecasting, robust logistics, and adequate financing is crucial.
- Systematic improvements are needed to ensure consistent availability of essential medicines in LMICs.
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