Lagos, Nigeria //- Healthcare consulting firm Salient Advisory has published a rapid assessment examining the role private pharmacy channels could play in expanding access to HIV, Tuberculosis (TB), and malaria care across 12 countries in Africa and Southeast Asia.
Titled Private Pharmacies as a Delivery Channel for HIV, TB, and Malaria Care, the report calls for country-level investigations into where formalising private pharmacy engagement could sustainably close persistent gaps in Antiretroviral Therapy (ART) access, TB case notifications, and malaria test-before-treat rates at a moment when global health funding is contracting and public-sector capacity faces increasing pressure.
The report covers the Democratic Republic of Congo, Ghana, Indonesia, Kenya, Mozambique, Nigeria, the Philippines, Rwanda, South Africa, Thailand, Uganda, and Zambia. Across the 12 countries, approximately 3.6 million people living with HIV are not yet on ART, around 764,000 TB cases go unreported each year, and test-before-treat adherence for malaria remains low across several high-burden markets.
Private pharmacies are already serving on the frontline of healthcare, with an estimated 188,000 licensed private outlets, independent pharmacies, drug shops, pharmacy chains, digital platforms, and software-enabled pharmacy networks operating across the 12 countries, collectively serving tens of millions of patients monthly.
For many TB, malaria and HIV patients in high-burden focus countries, these private pharmacies are critical, acting as the first point of care for 42% – 74% of TB patients and 41% – 60% of malaria patients. Pharmacy channels are also particularly important for HIV patients, helping them avoid public facilities due to stigma or, in some contexts, legal exposure.
This patient behavior is reflected in the regulatory environment across most of the 12 markets, which already permits some pharmacy-based services. The regulatory landscape broadly enables private pharmacies to provide HIV testing and referral, TB case finding, and malaria diagnosis and treatment. Engagement strategies must work within existing constraints, while identifying markets where reform or task-shifting could expand pharmacy-level services.
The report reveals that where pharmacy-channel engagement has been structured and resourced, early results have been measurable. In South Africa, a pharmacy chain-based antiretroviral therapy pick-up program maintained viral suppression in 97% of patients at 12 months, on par with facility-based care.
In Kenya, a diagnosis-contingent reimbursement model tested in a randomized controlled trial produced a fourfold improvement in malaria rapid diagnostic test uptake and reduced treatment costs by 50 to 80% per patient.
Based on 2024 data on ART initiations, TB notifications and malaria cases, and early evidence from programs already operating, the report illustratively estimates that structured pharmacy-channel engagement could support more than 650,000 additional ART initiations, over 116,000 additional TB notifications, and RDT-confirmed malaria treatment for up to 15.8 million patients.
In addition, the channel could play an important role in supporting the introduction of new products such as generic lenacapavir and Merck’s MK-8527 – an investigational antiretroviral (ARV) drug that is being studied as a potential PrEP product.
Speaking on the publication of the report, Abdullah Yusuf, Associate Director at Salient Advisory, commented: “The conditions we found, delivery gaps, channel presence, documented care-seeking, regulatory permissions, and proof points from programs already operating, amount to a case for taking the channel seriously, examining its potential market by market, disease by disease. The question is where those conditions converge sufficiently to justify moving from evidence to action.”
Salient Advisory is calling on governments, donors, and global health institutions to commission country-level investigations in markets where delivery gaps, channel presence, patient demand, regulatory feasibility, and financing pathways converge, and to treat the private pharmacy channel as a practical complement to public systems, not an afterthought.
The full report is available here.
