Anti-tuberculosis Drugs Stock-outs: Interruptions and Implications

Stock-outs of anti-tuberculosis drugs have serious implications. One of the challenges of managing TB patients is ensuring compliance with treatment for at least six months.[1] A large proportion of TB patients in India are from lower socioeconomic strata.[2] An uninterrupted supply of drugs from government sources is crucial to ensuring compliance among these patients. A lack of supply from government TB centers also undermines the moral authority of healthcare professionals who counsel patients on compliance. Short supplies may require patients to make more frequent visits to collect the drugs, as they may only receive a couple of day’s worth instead of a week’s or longer duration, depending on how far they need to travel. This results in additional travel expenses and lost wages, which many poor patients can ill-afford. Money may have to be diverted from other essential needs, such as food, further compromising recovery of the TB patient. Non-adherence to TB treatment can adversely affect both the patient and society. Treatment interruption has been significantly associated with unsuccessful outcomes.[3] At the societal level, an untreated patient with active TB is a source of infection to others. Treatment interruption is also one of the risk factors for the development of drug-resistant tuberculosis. Among several factors, treatment interruption has been identified as a major risk factor for the occurrence of additional drug resistance strains, such as pre-XDR-TB, or XDR-TB.[3] Managing and treating TB presents unique challenges. Both drug sensitive TB (DS-TB) and drug-resistant TB (DR-TB) require a multi-drug regimen involving a combination of drugs. It is imperative that, despite the difficulties, patients receive these drugs without supply chain disruptions. India contributes 25% of the global burden of TB.[4] If India fails to ensure uninterrupted supply of drugs to its large number of TB patients, the global fight against TB will be lost.[5] A greater political commitment and prioritization at the policy-making level are urgently needed to address the bottlenecks in the supply of anti-TB drugs. Failing this, we will encounter morbidity, mortality, and catastrophic costs associated with the disease. A quote by Martin Luther King Jr[5] aptly sums up the urgency, “We are now faced with the fact that tomorrow is today. We are confronted with the fierce urgency of now. In this unfolding conundrum of life and history, there “is” such a thing as being too late. This is no time for apathy or complacency. This is a time for vigorous and positive action.” Data availability statement Not applicable. Author contribution AB was responsible for all stages of the paper from concept, writing, drafting, revising and approval of the final version.