Drugs, injectables and related supplies in NTEP

Under the National TB Elimination Programme (NTEP) a comprehensive supply management system is maintained through Ni-kshay Aushadhi wherein all the stocking points and implementing health facilities are required to update the stock utilisation, consumption, requirement and expiry on a near to real-time basis. The requirement of all items at all levels is then calculated based on the data reported.

Injectables under NTEP

• The injectables used in TB treatment under NTEP are as follows:

  • Amikacin

  • Streptomycin

  • Kanamycin

  • Capreomycin

• Amongst these, Amikacin and Streptomycin, have been downgraded to Group C under the World Health Organisation's (WHO) reclassification of anti-TB drugs and are not included if an adequate regimen can be built without them.

• Kanamycin and Capreomycin are also no longer recommended for use.

• They are currently used only in special situations where the regimen cannot be completed and are supplied as Type B boxes.

• The District TB Officer (DTO) is responsible for issuing the injectables and the Peripheral Health Institute Medical Officer (PHI-MO) along with the Directly Observed Treatment (DOT) provider is responsible for making suitable arrangements during the intensive phase of the treatment for daily injections.

Other Related Supplies

• The other supplies required whenever the injectable TB treatment regimen is used are as follows:

  • Water container

  • Disposable tumblers

  • Sterile water

  • Disposable needles and syringes

  • Cotton

  • Methylated spirit

• In order to ensure accurate DOT, the DOT centre should have all the related supplies matched to the number of injection vials that are stocked in the centre.

• There should also be a sufficient number of disposable needles and syringes for giving injections along with cotton and methylated spirit to ensure that the injections are always given under sterile conditions.

• An adequate supply of sterile water, with enough water containers and disposable tumblers, must be ensured.

Procurement Injectables and Related Supplies under NTEP

The procurement of second-line drugs under the programme is done centrally depending on the policies and funding mechanism either through the Central Medical Services Society (CMSS) or through the Global Drug Facility (GDF). These are then distributed to implementing levels via State Drug Stores (SDS), District Drug Stores (DDS), Tuberculosis Unit (TU) and PHI. Other treatment-related supplies can also be procured at the state/ district level following NTEP guidelines/ General Financial Rules (GFR).

Resources

• Standard Operating Procedure Manual Procurement & Supply Chain Management, CTD, MoHFW, India, 2018.
• Procurement, Supply Chain Management & Preventive Maintenance, Module 6, CTD, MoHFW, India.
• Guidelines on Programmatic Management of Drug-resistant TB (PMDT) in India, CTD, MoHFW, India, 2021.

Assessment