DOTSPlus Meeting

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
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
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