Design and implementation of a drug revolving fund for hypertension treatment in primary care setting of the Federal Capital Territory, Nigeria

BACKGROUND: Expanding treatment for hypertension requires ensuring access to affordable, high-quality blood pressure (BP) lowering medications. We describe the design, implementation and evaluation of a BP-lowering medication drug revolving fund (DRF) embedded in the Hypertension Treatment in Nigeria (HTN) Programme in 60 primary healthcare centres (PHCs) in the Federal Capital Territory, Nigeria. METHODS: We used the exploration, preparation, implementation and sustainment framework to describe the DRF design and implementation and the reach, effectiveness, adoption, implementation and maintenance framework to report implementation outcomes. From June 2022 to December 2023, the DRF programme was implemented, and the data were collected from PHCs' drug stock and finance records, quarterly DRF-supportive supervision visits and the HTN Programme. We performed descriptive statistics using complete case analysis and used an interrupted time-series design to explore temporal trends in the 3-month rolling average rate of BP-lowering prescriptions dispensed. RESULTS: DRF design and implementation strategies included stakeholder engagement, leveraging the existing supply systems, developing medication and financial management protocols, training of site staff and DRF-supportive supervision visits, including joint problem solving. DRF was implemented in all 60 PHCs (100% reach). Adoption was high, with an increase in facilities selling DRF-supported medications from 80% to 100% (p value=0.01). Fidelity improved, including correct financial documentation (70%-100%; p value<0.0001) and stock cards (68%-94%; p value=0.0004). Effectiveness was high with low rates of medication stockouts of DRF-supported medications (1.7%-16%), with most medications at affordable prices, but a 12.1% drop in BP-lowering medications dispensing rate when the DRF replaced study-supplied free medication. Maintenance was high, with 100% of PHCs having a functional DRF after 1 year. CONCLUSION: A DRF programme to expand access to BP-lowering medications was implemented and effective in the Federal Capital Territory, Nigeria, and may serve as a model for other hypertension control programmes.