Success#Stories#from#the#States,#RNTCP#Annual#Status#Report,#2011#
International' Pharmaceutical' Federation' (FIP),' SEARPharm' Forum' (FIP"WHO' Forum' of' National' pharmaceutical' Associations' of' South' East' Asia)' (SPF)' and' Indian' Pharmaceutical' Association' (IPA)' with'support'of'Lilly'MDR'TB'partnership'have'launched'a'“DOTS'TB'Pharmacist'Project”'in'Mumbai.' The' project' involves' private' retail' Pharmacists' (at' the' chemist' shops)' to' deliver' DOT' services' and' thus'TB'patients'can'have'easier'access'to'the'treatment.'The'project'is'being'implemented'with'the' help' of' local' Chemist' Associations' and' ' City/District' TB' authorities.' Around' 130' Pharmacists' in' Mumbai' and' ' Thane' district' are' trained' with' the' help' of' City' TB' authorities.' The' key' role' of'
Pharmacists'is'case'Detection,'case'referral'for'diagnosis'(sputum'test),'awareness'and''counseling'
using' TB' information' leaflets,' developed' in' local' languages' and' Provision' of' DOT' medicines' at' the' Pharmacy.'The'project'will'be'spread'to'4'more'cites'in'India'and'plans'to'engage'around'500'more'
Pharmacists'by'the'end'of'2011.' 10. Drug'Logistics'Management,'Pune'
Success#Stories#from#the#States,#RNTCP#Annual#Status#Report,#2011'
Drug'requirements,'consumption'and'stock'positions,'both'at'State'and'district'levels'are'monitored' at' the' Central' TB' Division' through' the' Quarterly' Reports' submitted' by' the' districts.' The' 1st' Line' Anti"TB'Drugs'procured'are'stored'at'the'six'Government'Medical'Store'Depots'(GMSDs)'across'the' country'and'issued'to'the'States'based'on'the'Quarterly'District'Program'Management'Reports'and'
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the' monthly' State' Drug' Stores' (SDS)' Reports.' The' States' are' required' to' maintain' defined' buffer' stocks' at' each' levels' i.e.,' at' the' PHIs,' TUs,' DTCs' &' the' SDS.' The' District' Quarterly' Reports' are' analyzed' in' detail' at' CTD' and' any' discrepancies' arising' are' notified' to' the' concerned' districts' &' States' for' necessary' corrections.' For' long"term' sustainability' of' the' program,' decentralization' of' inventory' management' practices' is' very' important.' To' ensure' that' the' States' are' able' to' manage' their' drug' logistics' as' per' RNTCP' guidelines,' regular' trainings' &' re"trainings' on' Drug' Logistics' Management' were' conducted' by' Central' TB' Division' for' the' State' &' district' level' staff' during' the' year.' These' trainings' were' imparted' to' State' level' officials,' District' TB' Officers' (DTOs),' State' and' District' level' Pharmacists' along' with' respective' RNTCP' Medical' Consultants.' Such' trainings' were' conducted' for' the' officials' in' Madhya' Pradesh,' Kerala,' Orissa,' Maharashtra,' Tamil' Nadu,' Puducherry,'A'&'N'Islands,'Punjab'and'Chandigarh.'In'addition,'all'the'RNTCP'Medical'Consultants' were' also' sensitized' to' Drug' Logistics' Management' practices' during' the' Biannual' National' Review' Meeting' held' at' Gurgaon,' Haryana' in' January,' 2010.' About' 450' RNTCP' officials/Consultants' have' been'trained'during'the'year'on'Drug'Logistics'Management.'The'DTOs'are'expected'to'further'train' their' sub"district' level' staff' involved' in' drug' logistics' in' their' respective' districts.' To' assess' the' impact' of' such' trainings,' CTD' is' also' regularly' re"visiting' some' of' the' States' already' trained.' Jharkhand,'Uttar'Pradesh,'Assam'and'Bihar'were'visited'during'the'year'by'teams'from'CTD.'Some' improvements' have' been' noticed' but' the' lack' of' commitment' by' concerned' officials' at' State' and' District'levels'is'still'seen'as'a'major'drawback.'Some'of'the'common'observations'noticed'are:'
1. Poor'drug'storage'conditions'&and'lack'of'infrastructure'at'the'drug'store' 2. Lack'of'contracted'transportation'arrangements'from'SDS'to'district'drug'stores'
3. No'full'time'pharmacist/store"keeper'at'the'SDS'and'no'designated'officer'to'monitor'drug' logistics'activities'in'the'states'visited.'
4. No' system' of' trainings/re"trainings' conducted' by' the' states' visited' for' Drug' Logistics' Management.'
5. Logistics' management' of' 2nd' Line' drugs' is' still' a' challenge' under' DOTS"Plus' in' RNTCP.' Cycloserine' and' Ethionamide' with' a' short"' shelf' life' require' continuous' monitoring' and' regular' Inter"State' transfers' to' ensure' maximum' utilization' and' minimum' expiry' of' these' drugs.' Currently,' 10' States' viz' Andhra' Pradesh,' Delhi,' Haryana,' Gujarat,' Kerala,' Maharashtra,'Orissa,'Rajasthan,'West'Bengal'&'Tamil'Nadu'have' already'implemented' the'
DOTS"Plus' program' in' their' respective' States' and' more' states' are' preparing' to' start' the'
treatment'services'under'DOTS"Plus'during'the'next'year.'Training'on'2nd'line'drug'logistics' is'also'being'imparted'during'the'regular'trainings'on'Drug'Logistics'Management'to'State'&' district'level'staff.'The'same'has'been'included'in'the'Standard'Operating'Procedures'(SOP)' Manual'for'both'State'and'District'Drug'Stores.'
19' ' ' ' 11. Private'pharmacies'in'tuberculosis'control':'Chennai'experience'' # Int#J#Tuberc#Lung#Dis.#2009#Jan;13(1):112H8.# Resource'Group'for'Education'and'Advocacy'for'Community'Health'(REACH)'lead'project'in'Chennai' sensitized' Pharmacists' through' sensitization' workshop' /one' to' one' interviews.' The' sensitization' focused'on'guidance'for'referral'of'chest'symptomatic'patients'to'REACH'or'the'nearest'government' microscopy' center' or' a' private' doctor' for' diagnosis,' guidance' for' referral' of' patients' who' bought' ATT' from' their' pharmacies.' Posters' publicizing' the' availability' of' free' drugs' for' TB' through' DOTS' were'distributed'to'the'Pharmacists'for'display.''Advocacy'and'counseling'of'patients'are'needed'for' regular'medication'by'the'Pharmacists.'
Brochures' containing' relevant' information' on' tuberculosis' symptoms,' diagnosis,' treatment' and' precautionary'advice'were'given'for'distribution'to'patients'buying'Anti'Tubercular'Treatment.' The'project'demonstrated:' ! Improved'knowledge'of'the'Pharmacists'' ! Improved'referrals'to'the'RNTP'' ! Increased'number'of'patients'put'on'DOTS' ! Improved'capacity'of'the'Pharmacists'in'patient'counseling''' ' 12. Biopharmaceutic'and'pharmacokinetic'aspects'of'variable'bioavailability'of'rifampicin.' ' Panchagnula#R,#Agrawal#S.#Int#J#Pharm.#2004#Mar#1;271(1H2):1H4.#
The' treatment' outcome' of' tuberculosis' can' be' questionable' due' to' variable' bioavailability' of' rifampicin.' The' study' at' National' Institute' of' Pharmaceutical' Education' and' Research' at' Mohali,' India,'reported'the'bioequivalence'trials'in'the'form'of'a'figure'that'provides'a'comprehensive'look' at'the'rifampicin'bioavailability'literature,'provides'understanding'of'the'problem'and'clears''myths' and'assumptions''regarding'rifampicin'bioavailability'from'FDCs.'It'was'found'that'FDCs'containing' rifampicin'with'reduced'or'increased'relative'bioavailability'are'available'in'the'market.'In'addition,' 'rifampicin'alone''formulations'also'show'variability'in'bioavailability.'' ' '
20' ' 7.'MEMORANDUM'OF'UNDERSTANDING'(MoU)'WITH'RNTCP'FOR'ENGAGING'RETAIL'PHARMACIES'IN' RNTCP' During'the'FIP'World'Congress'2011'in'Hyderabad'FIP/WHO'Joint'Statement'on'the'role'of'Pharmacists' in'TB'Care'and'Control'was'adopted'(See#AnnexurH3).'The'joint'statement'called'for'seven'collaborative' actions'between'the'NTPs'and'the'NPAs.'
Consequent' to' the' FIP/WHO' Joint' Statement' a' follow' up' a' Round' Table' of' stakeholders' to' utilize'
Pharmacists' in' TB' Care' and' Control' in' India' took' place' during' the' 2011' FIP' World' Congress' in'
Hyderabad.'To'provide'joint'stewardship'the'round'table'recommended'development'of'policy'guidance' and'resource'mobilization'to'engage'Pharmacists'in'TB'Care'and'Control.'It'was'further'recommended' that'there'needs'to'be'a'formal'national'plan'or'strategy'to'engage'Pharmacists'in'the'RNTCP.'A'Pan" India'Working'Group,'led'by'the'IPA'and'working'in'close'collaboration'with'all'stakeholders,'especially' AIOCD,'Pharmacy'Council'of'India'and'SEARPharm'Forum,'should'be'established'as'soon'as'possible'and' help'develop'this'plan'in'line'with'the'RNTCP'program'objectives'2012'to'2017.'' Subsequently,''Memorandum'of'Understanding'between'The'Central'TB'Division'Directorate'General'of' Health' Services,' and' Indian' Pharmaceutical' Association' (IPA)' ' All' India' Organization' of' Chemists' &' Druggists'(AIOCD),''Pharmacy'Council'of'India'(PCI)'and'SEARPharm'Forum'was'signed'(AnnexureH4)' '
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8.'CONCLUSION'
The' FIP' Challenge' on' TB' Round' 1' project' showed' that' Pharmacists' involvement' in' India' in' prevention' and' care' ' is' still' at' a' nascent' stage.' However,' it' very' clearly' brought' out' that' there' is' an' immense' potential' for' Pharmacists' in' India' to' participate' in' the' Revised' National' Tuberculosis' Program' and' contribute' to' the' different' areas' of' the' intervention.' The' available' case' studies' showed' few'
Pharmacists'' activities' in' TB' Prevention' and' Care.' The' MoU' brought' out' following' mitigation' strategy'
needs'to'be'used'urgently'by'the'IPA'with'RNTCP:' 1. Training'and'education'of'Pharmacists'and'up"gradation'of'curriculum'at'all'levels.' 2. Creating'awareness'that'Pharmacists'are'playing'important'role'in'TB'Care'and'Control.' 3. Strengthening'of'the'distribution'and'retailing'of'TB'medicines'by'adequate'training.' 4. Pharmacists'as'DOTS'provider'can'improve'proper'use'of'anti'TB'medicines,'prevent'misuse' and'help'in'early'case'Detection'and'referral'to'RNTCP.'
5. Partnership' in' Implementation' of' standard' treatment' guidelines' and' continuing' education' with'other'healthcare'providers.'
6. Creating' awareness' through' counseling.' The' most' accessible' practicing' Pharmacists' cover'