Supply-paced eligibility: aligning clinical policy and supply chains during HIV treatment transitions

Abstract

Brazil’s phased introduction of fixed-dose dolutegravir/lamivudine (DTG/3TC) illustrates a broader challenge in HIV programmes: how to expand access to new treatment technologies while procurement, inventory and distribution capacity are still adjusting. This Viewpoint proposes the concept of supply-paced eligibility to describe the deliberate sequencing of eligibility expansion so that clinical policy and supply systems can move together. Brazil progressively broadened eligibility for fixed-dose DTG/3TC from 2023 to 2025, while Ministry of Health data show rapid growth in national consumption during the transition. We argue that eligibility thresholds may serve not only clinical prioritization but also a temporary supply-management function. Such use should be explicit, measurable and time-limited, supported by demand forecasting, safety-stock planning for legacy and replacement presentations, and predefined indicators of supply readiness. Equity monitoring should accompany each phase of expansion to avoid reproducing disparities in access. Brazil’s experience suggests that eligibility decisions, procurement planning and equity monitoring should be considered together when HIV programmes introduce new technologies.