On October 1, the Health Ministry issued a press launch for the second time in 5 days stating that “media reports claiming shortage of anti-TB medicines are false, motivated and misleading”. Since June this 12 months, there was a stockout of Linezolid, Clofazimine, and Cycloserine, three essential medicines used for treating MDR-TB.
“The CTD [Central TB Division] has to supply all TB drugs and there should be a buffer stock for three months at the State-level. But in the last one year, there have been interruptions in TB drug supply. It has become severe in the last few months,” Dr. Peeyush M, Kerala State TB Officer advised The Hindu. “CTD has been issuing permissions for local purchase of certain drugs, but mostly at the last minute. This is creating challenges at the field-level. So far, supply of TB drugs [to patients] has not been interrupted due to the support of the State government.”
Dr. Peeyush additionally mentioned that Kerala has not been receiving many TB medication like Rifampicin and Isoniazid for a very long time. “Kerala has received a stock of Clofazimine one week back. But the stock will last only for a month. As of today, we have not received any stock of Linezolid and Cycloserine. We are expecting a stock of Cycloserine in the next few days,” he mentioned. Even for medication used in the course of the TB continuation section for paediatric sufferers, the State has buffer inventory for lower than three weeks although it must be for 3 months as per tips, he mentioned.
According to him, apart from the TB medication scarcity, Kerala additionally confronted a stockout of TB exams (CBNAAT) for Truenat final 12 months; the State had to procure them domestically. The Central TB Division is supplying sufficient Truenat consumables now. However, the inventory of CBNAAT cartridges will final solely until November 15 and the State is yet to receive contemporary provides.
“Our biggest challenge is with drugs used for TB preventive therapy. For the last six months we have not received any supply of 3HP (isoniazid-rifapentine) FDC [fixed-dose combination] for those above 15 years. Instead, we received loose drugs in piecemeal quantities. This leads to pill burden and reduced adherence,” he mentioned. “So far, we have ensured that there is no treatment interruption by obtaining drug transfer advice from other States. But now the State is in a difficult position to initiate 3HP TPT [TB preventive therapy] for eligible contacts. But with the support of the State government, we are exploring ways to tide over the situation including local procurement, relocation or change in regimen with the support of the State Technical Working Group for TPT.”
As Kerala doesn’t have many TB drug distributors, a majority of TB medication are procured from Tamil Nadu. “After a few instances, whatever be the situation with the drug supply from the Central TB Division, the State is planning for local procurement of key TB drugs, at least for a few months to maintain the buffer stock. This is in anticipation of challenges that may arise due to heavy rains in the next few months,” mentioned Dr. Peeyush. “Currently, for a majority of MDR-TB drugs the State does not have buffer stock as districts are buying the drugs.”
