AIDSTAR-One Success Story: Disposal of Expired ARVs and Test Kits in Nigeria

In Nigeria, hundreds of tons of pharmaceuticals are shipped into or produced within the country each year to treat approximately 4 million HIV-positive individuals receiving antiretroviral therapy (ART). A fraction of these medicines expire before they can be used, resulting in tons of hazardous medical waste. Many health facilities in Nigeria lack a system for disposing of expired pharmaceuticals. These drugs are often partially burned in open fields, releasing toxic gases that can harm people living in the area. The drugs that escape the flames are sometimes picked through by scavengers, and some are even repackaged and sold as counterfeits. Ingesting expired medications can be lethal, and for HIV-positive individuals who rely on ARVs, an expired drug can have a detrimental impact on their health. The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) Nigeria Prevention and Logistics Technical Working Group and its implementing partners requested technical assistance from the AIDSTAR-One project and the Supply Chain Management System (SCMS) project to coordinate a "waste drive" to dispose of expired ARVs, HIV test kits, and laboratory chemicals. The AIDSTAR-One project, funded by PEPFAR through the U.S. Agency for International Development, provided technical assistance to estimate the quantity of expired commodities and map the locations and capacities of final treatment sites in the country. With their estimate complete, AIDSTAR-One and SCMS combined logistic and waste management expertise to deal with approximately 70 tons of expired product generated from July 2005 to April 2010. The waste was transported to a central location, a BOSKEL Nigeria, Ltd. facility in Port Harcourt, where it could be incinerated according to international best practices and in line with World Health Organization rules and regulations. BOSKEL's incinerators are equipped with special devices, including "scrubbers" and "quenchers," that reduce the amount of gas released into the air while the expired medicines are being converted to ash. The initiative also focused on improving forecasting and supply chain management for ARVs and other expired drugs and products, enabling facilities to quantify and reduce waste. Joseph Enesi, Program Officer with the Christian Health Association of Nigeria/Nigeria Indigenous Capacity Project, noted that the waste drive has been a positive contribution to the improvement of their logistics system. With better pharmaceutical waste management procedures in place, fewer of these once life-saving medicines will end up as hazardous waste, and those that expire will be properly disposed of to prevent harm.