Transcript Slide 1

Group - 3
DOTS-Plus Meeting
12 Apr 2005
Task
• Information system
– Recording
– Reporting
• Linkages with field and follow-up for
discharged patients
• Drugs
– Drug procurement
– Drug packaging
– Drug distribution system
Patient flow (linkages with field and
records) …1
• Fill sputum culture form for Cat II failure
• Send sputum/patient to IRL with culture form and
treatment card
• RNTCP Lab committee to provide guidelines for
packaging and transportation of sputum for culture
• MDR diagnosis at IRL communicated to DTO by email,
telephone and post/courier
• MDR Lab register at IRL
• DTO/MOTC conducts address verification
• Patient sent to State MDR Hospital for admission
Patient flow (linkages with field and
records) …2
• Hospital fills up patient details record and treatment book
and patient I-Card
– Treatment book consists of Rx card, adverse reaction monitoring
chart, bacteriology chart
• Local DOT provider and family treatment supporter
identified and trained
• Discharge after one month with 1 week drug supply to
patient and copy of treatment book, referral form and
drugs for remaining IP (8 months) sent to DTO
(courier/messenger)
• DTO to send back portion of referral form to State
hospital as feedback on receipt of patient and drugs
Patient flow (linkages with field and
records) ….3
• Sputum samples for culture as and when required to be
sent to IRL by courier (patient could also go if possible)
• To reduce number of cultures consider doing culture only
when sputum AFB becomes negative. Reduce no. of
cultures to the optimum scientifically acceptable. ???
• RNTCP to fund specimen shipment / travel of patient to
IRL/State hospital
• DTO to send copies of treatment book to State hospital
at the end of every quarter
• State hospital to maintain MDR TB register
• State hospital to supply CP drugs to DTO 6-monthly (first
supply before IP is over)
Recording system
• Laboratory request forms (will act as referral
form to IRL)
– Culture/Sensitivity form
•
•
•
•
MDR Lab Register at IRL
Patient details record (case sheet) at hospital
Patient I-Card
Patient treatment book
– Consists of Rx card, adverse reaction monitoring
chart & bacteriology chart
• Referral form to DTO for ambulatory Rx
• MDR TB Register at State hospital
Reporting
• Case finding report (quarterly, annually)
• Conversion report (quarterly and annually; after 13 to 15
months later, just like RT report of DOTS)
– E.g. patients initiated on treatment in Q1 2005 will be reported in
the Q1 2006 report
• Treatment outcome report (quarterly and annually; after
31 to 33 months later, i.e. after 10 quarters)
– E,g. patients initiated on treatment in Q1 2005 will be reported in
Q3 2007
• MDR-TB register to be computerized in the form of a
line-list at State hospital/IRL level and networked
• Separate quarterly drugs and lab supplies report from
State
Drug procurement
• Procurement only at national level
• Annual procurement with 6-monthly
tranches
• Two mechanisms available
– ICB
– GLC
– GOI to take decision
Drug procurement (…2)
ICB
Advantages
• Lower cost
• Readily acceptable to WB
• Quality assured
• Known system for country
Disadvantages
• Long lead time
GLC
Advantages
• Shorter lead time
• Quality assured
• International standards
Disadvantages
• Higher costs
• Port clearance for drugs
sourced from outside country
• Taxation
• Mechanism of transfer of funds
to GLC
May be good to have 2 procurement mechanisms: ICB for WB funded
States and GLC for GFATM funded states
Drug packaging
• Recommended packaging of drugs into
multi-drug single day blisters
• State hospital to further package drugs
into 8-month IP and 6-month CP packs
• Additional loose drugs need to be
considered
Drug distribution system
• Manufacturer to send drugs directly to
State hospitals
• RNTCP to provide funds and guidelines
for drug stores at hospital
• State hospital releases drugs to DTO
• Quarterly reporting of drug stocks to CTD