Multi-Drug Resistant Tuberculosis (TB): Managing second line TB medicines effectively

Multi-Drug Resistant Tuberculosis (TB) is a growing global health concern. MDR-TB can be treated but involves a long, complex and costly treatment regimen that includes second-line TB medicines with many side effects and toxicities. When treatment is started it must be continued until completion or there is a risk of developing extreme resistance.

Achieving an accurate forecast for procurement of second-line TB medicines to treat MDR-TB is challenging. MDR-TB treatment programs are new and expanding and there is a lack of reliable data available for forecasting. As a result many assumptions must be made, such as the future number of patients on empirical and standard treatment regimens, changes in regimens due to toxicities, treatment interruption due to death or treatment failure and patient adherence to treatment. With this number of assumptions the accuracy of the forecast can be compromised and the risk of stockouts or overstocking, if predicted assumptions prove incorrect, is high.

Due to the unpredictability of MDR-TB treatment, quantification should not be a stand alone activity but must be supported by ongoing monitoring, collection and analysis of consumption data. This data should be used to review and update the forecast and adjust procurement quantities to ensure an adequate supply of medicines is available at all times while avoiding costly overstocking. National TB Programs need to establish a clear quarterly plan to collect data, review and recalculate shipment quantities, monitor stock levels and expiration dates to reduce the risk associated with uncertain forecasting.