The consumption of anti-tuberculosis drugs in the State has fallen by around 40% in 2019 when compared to figures from 2015, indicating a fall in TB case burden, according to a recent report of the State TB Officer and the State Drugs Control Department.
Recording commercial drug sale data helps estimate the disease burden outside public health facilities which may go undetected in the “absence of 100% reporting of surveillance data on privately treated patients”, it says.
The report records the sale of rifampicin, a key drug that is part of the TB treatment regimen. While the drug may be used in some cases to treat infections or conditions such as leprosy, in 90% of the cases it is used against tuberculosis, says P.S. Rakesh, World Health Organization consultant for TB elimination for Kerala and Lakshadweep.
The sale of the drug in the private sector fell by around 70% in 2019, when compared to figures in 2015, while anti-TB drug consumption under the National Tuberculosis Elimination Programme (NTEP), which provides free medication at government facilities, fell by around 20%.
A fall in drug consumption both in the government and private sectors indicates a real decline in TB incidence in the State, says M. Sunilkumar, State TB Officer. “There is an increased uptake of NTEP drugs among patients diagnosed at private hospitals. Under the State government’s STEPS (System for TB Elimination in the Private Sector) initiative, patients being treated at private hospitals can avail themselves of NTEP drugs while continuing treatment at private facilities itself,” he says, explaining the greater dip in private sector drug sales.
To determine a trend, the rifampicin units sold are converted into “patient months”, which is the requirement of rifampicin units for a single patient for 28 days. The State has been using figures from 2015, 2017, and 2019 so far to determine the fall in sales.
In terms of patient months, rifampicin sales fell from 91,498 months in the private sector in 2015 to 28,072 in 2019. Revised National TB Control Programme (RNTCP) drug consumption in terms of patient months fell from 1,34,227 in 2015 to 1,08,377 in 2019. The general course of treatment is six months.
Since rifampicin is a Schedule H1 drug, which means that its sale is regulated and it can be purchased only with a prescription and details of the patient will be noted in registers at pharmacies, the State Drugs Controller provides regular data on its sale to the State TB Officer.
Around 380 private hospitals are part of the STEPS initiative, which has improved notification of cases from private hospitals.
In 2019, 25,614 TB cases were notified (20,687 in the public sector and 4,928 cases from private hospitals). A total of 21,206 cases were notified in 2020.
