Group - 3

1. Group - 3 DOTS-Plus Meeting 12 Apr 2005

2. Task • Information system • Recording • Reporting • Linkages with field and follow-up for discharged patients • Drugs • Drug procurement • Drug packaging • Drug distribution system

3. 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

4. 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

5. 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)

6. 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

7. 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

8. Drug procurement • Procurement only at national level • Annual procurement with 6-monthly tranches • Two mechanisms available • ICB • GLC • GOI to take decision

9. 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 Drug procurement (…2) May be good to have 2 procurement mechanisms: ICB for WB funded States and GLC for GFATM funded states

10. 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

11. 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