On October 1, the Health Ministry issued a press release for the second time in five days stating that “media reports claiming shortage of anti-TB medicines are false, motivated and misleading”. Since June this year, there has been a stockout of Linezolid, Clofazimine, and Cycloserine, three important 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 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 told 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 also said that Kerala has not been receiving many TB drugs like Rifampicin and Isoniazid for a 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 said. Even for drugs used during the TB continuation phase for paediatric patients, the State has buffer stock for less than three weeks though it should be for three months as per guidelines, he said.
According to him, besides the TB drugs shortage, Kerala also faced a stockout of TB tests (CBNAAT) for Truenat last year; the State had to procure them locally. The Central TB Division is supplying enough Truenat consumables now. However, the stock of CBNAAT cartridges will last only till November 15 and the State is yet to receive fresh supplies.
“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 said. “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 does not have many TB drug distributors, a majority of TB drugs 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,” said Dr. Peeyush. “Currently, for a majority of MDR-TB drugs the State does not have buffer stock as districts are buying the drugs.”
