Flow of Dlm in NTEP

• Delamanid (Dlm) is  a second line anti TB drug for Drug Resistant (DR) TB patients, supplied in the form of strips containing 8 tablets having dosage strength of 50mg with 60 months of shelf life. According to National TB Elimination Program (NTEP) guidelines, total 84 strips of Dlm tablets (672 tablets) are required to complete a full course for a patient (i.e, 100mg BD daily dosage) for 6 months of Intensive Phase (IP).
• During the first 5 months, the patient will receive 120 tablets of Dlm each month (15 strips) and in the 6th month, the patient will receive only 72 tablets (9 strips) as Dlm is given only for 24 weeks.

Flow of Delamanid under NTEP

Figure: Flowchart depicting Drug-flow of Delamanid

• The Dlm drug is procured centrally and supplied to the Government Medical Store Depot (GMSD)/Central Medical Services Society (CMSS).

• Based on the reports from the Ni-kshay Aushadhi, Central TB Division (CTD) prepares the Release Order (RO) following which the drugs are supplied to the respective State Drug Stores (SDS).

• In case of Dlm, the drug is dispatched from the SDS to the Nodal/ District Drug-resistant TB Centre (N/DDR TBC) as the patients should be initiated on Dlm,  preferably in an in-patient setting for a period of two weeks (15 days) in order to observe for tolerance of the patients to the regimen.

• Upon discharge from the N/DDR TBC, patients initiated on Dlm are issued the Dlm strips for the rest of the first month which is handed over to the treatment supporter under the supervision of the senior DR-TB/ TB-HIV supervisor.

• Post discharge, the Dlm drugs are directly supplied from the SDS to the respective DDS of the district where the patient will be continuing further treatment.

Resources

• Guidelines for Use of Delamanid for Treatment of DR-TB in India, 2018, CTD, MoHFW, India.
• Procurement, Supply Chain Management & Preventive Maintenance, Module 6, CTD, MoHFW, India.

Assessment