Strengthening TB Notification Through Chemists: A Public-Private Partnership Approach
Engaging chemists to improve TB notification rates has been identified as crucial, especially with over 46% of TB patients not known to national programs initially seeking care in the private sector. The government has implemented interventions such as restricting over-the-counter sales of TB drugs and requiring prescriptions from registered medical practitioners. Through administrative actions and district preparedness initiatives, efforts have been made to sensitize chemists and improve reporting. The outcome shows progress, with 41% of chemists now selling anti-TB drugs. Utilizing TB notification information from chemists has led to the development of policies to enhance partnerships and provide free TB drugs under RNTCP.
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Engaging Chemists to Strengthen TB Notification
Background 46% TB patients not known to National Programme Plos One 2011; 6(9): e24160 > 80% of initial care-seeking is in private sector Plos One 2012; August 6 Based on prescriptions from informal health care providers anti-TB drugs was available over-the-counter Inspite of TB being a Notifiable Disease NOT all private practitioners are notifying
Opportunity Government Notifies Schedule H1 drugs Over-the-counter sale of 46 drugs restricted from March 1, 2014 The list includes 11 anti-TB Drugs will carry a Boxed Label Warning that should not be sold without a prescription issued by Registered Medical Practitioner self-medication of the drug preparation can be dangerous. The new rule mandates the chemists and druggists To maintain sales register and To retain the physician s prescription copy as a proof of drug sales.
Administrative Actions DHS letter to Commissioner FDA Commissioner FDA to Chemist Associations DHS letter to CMHOs
District Preparedness & Actions Sensitization workshop of Chemists by the districts Monthly Coordination Meeting of Drug Inspectors with RNTCP staff Drug Inspectors collect notification information from Chemists in a structured format.
Outcome of Efforts Chemists - Sales of Anti-TB Drugs TB patients notified from Chemists 5117 4965 Selling Anti-TB Drugs 41% 3386 Chemist NOT selling Anti-TB Drugs 59% 755 2Q16 3Q16 4Q16 1Q17
TB Notification from Chemist - Tool to Strengthen Private Partnership TB Notification information from Chemists is being utilized to track back those private practitioners NOT notifying TB cases State-wide baseline information now available that 41% chemists sell anti-TB drugs Policy being developed to partner with Chemists for providing FREE anti-TB drugs under RNTCP
Impact on TB Case Notification Public & Private Sector (per lac population) 142/lac 126/lac 128/lac 33 104/lac 20 18 4 109 108 108 100 FY 13-14 FY 14-15 FY 15-16 FY 16-17 ACNR Public ACNR Private
50% TB patients treated in Private Sector Bilaspur Raipur 100 108 75 59 90 110 110 80 4Q16 1Q17 4Q16 1Q17 TB in Public Sector TB in Private Sector
Way Forward. De-duplication of TB Notification from Private Practitioners & Chemists to generate accurate information Plan to Keep FREE Anti-TB Medicines at Selected Chemists & Private Practitioners Drug Sales data from chemists can be utilized for estimating privately treated TB cases Anti-TB prescription practices of private sector is there a need to regulate wrong treatment practices??
Undernutrition and Tb In chhattisgarh 40000 new patients every year Undernutrition is a much bigger problem than MDR Tb 90% of our people with tuberculosis are malnourished, 55% have severe undernutrition average weights of adults with tuberculosis are (PLOS One 2013, JSS study) 33 kg in women and 39 kg in men.
What can Supplemental food do to Tuberculosis care Deaths reduced by two thirds Improved compliance: food , less side effects Improved weight gains Return to work Possibly less relapses
Mukhyamantri Kshay Poshan Yojana 1 kg milk powder, 1.5 kg shelled groundnuts and 1 kg soyabean oil each month for all Tb patients for entire course First state in India to do this: trailblazer Budgetted in the state budget.
