Drug stock-outs in HIV, tuberculosis, and malaria programs: a systematic review

Abstract

Background Stock-outs of antiretroviral, anti-tuberculosis, and anti-malarial medicines remain a major challenge in low- and middle-income countries, affecting both health systems and patient outcomes. This systematic review aimed to synthesize evidence on the causes, consequences, and mitigation strategies related to these stock-outs. Methods A systematic search of PubMed, Embase, Web of Science, and Scopus was conducted for studies published between 01, January 2000 and 17, March 2026. Studies reporting stock-outs of antiretroviral or/and anti-tuberculosis or/and anti-malarial medicines were included, while those published before 2000 or focusing on other medicines were excluded. Findings were synthesized using a non-quantitative approach and heterogeneity was assessed qualitatively. The quality of the studies was evaluated using Joanna Briggs Institute (JBI) critical appraisal check list. The review was registered in PROSPERO (CRD42021296472). Findings Of 10,158 screened records, 56 studies were included. Key causes of stock-outs included supply chain inefficiencies, procurement delays, inadequate funding, weak governance, and poor demand forecasting. Consequences included treatment interruptions, increased drug resistance, and higher morbidity and mortality, along with increased out-of-pocket costs and emergency procurement burdens. Mitigation strategies ranged from short-term responses, such as emergency purchasing and redistribution, to long-term system strengthening, including improved procurement systems, buffer stocks, supplier diversification, and digital inventory management. Interpretation Review demonstrates that the causes of reported stock-outs in HIV, tuberculosis, and malaria programmes are largely preventable and the solutions lie in fortifying supply chain system with better forecasting robust logistics and sufficient financing. Funding Wellcome trust CAMO-Net programme and Global Antibiotic Research and Development Partnership.