Kerala Still Awaiting TB Drugs Linezolid and Cycloserine

Shortage of Anti-TB Medicines in India Sparks Controversy

Last week, the Indian Health Ministry issued a press release denying media reports of a shortage of anti-TB medicines in the country. However, healthcare professionals and experts suggest that the situation is far from false or misleading. Since June of this year, a severe stockout of key medicines used to treat multidrug-resistant tuberculosis (MDR-TB) has plagued the nation.

Supply Interruptions and Buffer Stock Shortage

According to Dr. Peeyush M, the Kerala State TB Officer, the Central TB Division (CTD) is responsible for supplying all TB drugs and maintaining a buffer stock at the state level. However, over the past year, there have been frequent interruptions in drug supply, with the situation worsening in recent months. Dr. Peeyush notes that while the supply of TB drugs to patients has not been completely interrupted thanks to the support of the state government, the challenges at the field level due to last-minute permissions for local purchases have created disruptions.

Moreover, Kerala has been facing a shortage of essential TB drugs like Rifampicin and Isoniazid for an extended period. Although a stock of Clofazimine was received last week, it is expected to last for only a month. Furthermore, the state’s buffer stock of drugs used during the TB continuation phase for pediatric patients falls short of the recommended three-month supply. These stock shortages not only undermine the guidelines for effective treatment but also pose a significant risk to patients’ health.

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Testing Supplies and Preventive Therapy Challenges

The scarcity of TB drugs is not the only concern in Kerala. Last year, there was also a stockout of TB tests, specifically the CBNAAT cartridges needed for Truenat testing. As a result, the state had to resort to local procurement. Although the Central TB Division is currently supplying enough Truenat consumables, the stock of CBNAAT cartridges is expected to last only until November 15, and fresh supplies are yet to be received. This further exacerbates the testing crisis in the state.

Additionally, Kerala is grappling with a critical challenge in TB preventive therapy. For the past six months, the state has not received any supply of the combined drug regimen, 3HP (isoniazid-rifapentine) for individuals above 15 years of age. Instead, they have been receiving loose drugs in varying quantities, leading to increased pill burden and reduced treatment adherence. While the state has managed to avoid treatment interruptions by obtaining drug transfers from other states, initiating 3HP preventive therapy for eligible contacts poses a significant challenge. The state government is working closely with the State Technical Working Group for TPT to explore options such as local procurement, relocation, or change in regimen.

Local Procurement and Rainy Season Preparedness

Kerala heavily relies on neighboring state Tamil Nadu for procuring TB drugs due to the limited number of distributors in the region. However, after facing several instances of interrupted drug supplies from the Central TB Division, the state is now planning to engage in local procurement of key TB drugs for at least a few months to maintain a buffer stock. This proactive step is taken in anticipation of potential challenges that may arise due to heavy rainfall in the coming months, which could further disrupt drug delivery.

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The shortage of MDR-TB drugs remains a pressing concern in various districts of Kerala, as they are forced to purchase the drugs on their own without the buffer stock typically provided by the state. The healthcare authorities are urging immediate action to address these shortages and ensure the proper availability of TB medicines.

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