Flow of DR-TB Drugs in NTEP

The DR-TB drugs are the Second Line Drugs (SLD) prescribed to the TB patients based on resistance pattern. The treatment duration varies from 9-20 months depending on the regimen being administered. These drugs are supplied as monthly Patient Wise Boxes (PWB) of Type A and Type B .The Type A boxes contains drugs that are common in Intensive Phase (IP) and Continuation Phase (CP) and Type B box contains drugs that are given only during the IP. 

The Flow of DR-TB Drugs in NTEP

Figure: Flow of DR-TB Drugs in NTEP

• The centralized procurement agency supplies loose form of SLD to the Government Medical Store Depot (GMSD)/Central Medical Services Society (CMSS).
• The GMSD/CMSS then transports the drugs to the various State Drug Stores (SDS) as loose drugs.
• In some special situations the GMSD directly sends the DR TB drugs to the District Drug Stores (DDS).
• At the SDS /DDS (as the case may be), the loose drugs are packed into standardized monthly PWBs of Type A ,Type B for various regimes and supplied to the Nodal/District DR TB Centre (N/DDR-TBC) ----> Tuberculosis Units(TUs) ---->  Health Facilities (HFs), each quarter.
• The patients are issued 1 monthly PWBs which should be handed over by the Senior Treatment Supervisor (STS) to the treatment supporter who is identified in consultation with the patient and provider.
• SDS shall also supply an additional loose quantity of SLD to the districts for special situations like modification of regimen/ extension of intensive phase etc.

DR-TB Drug Distribution Management

The whole process of drug distribution is carried out through a well-defined transportation mechanism/ Third-party Logistics (3PL). The SDS/ districts should follow up with the GMSDs/ CMSS in case of delay in receipt of drugs after receipt of the release order from the CTD. Once the reports are received by SDS from DTCs through Nikshay Aushadhi, it takes around 10 days for SDS to process the requirement (from all districts). All stocking points need to maintain a reserve stock of Type A and Type B PWBs except in case of HFs,  where in only those HF's  where patients are 'initiated' OR are 'on treatment'  for DR TB shall maintain a reserve stock of SLD.

Resources

• Standard Operating Procedure Manual Procurement & Supply Chain Management, CTD, MoHFW,India,2018
• Procurement, Supply Chain Management & Preventive Maintenance, Module 6, CTD, MoHFW, India.

Assessment