FDC (Fixed doses combination) &

99 DOTS

Dr Yogesh Patel & Dr Hiren Thanki

4FDC

3FDC

Daily Dose Schedule for Adults (as per weight bands)

Weight band Number of tablets Inj.

Streptomycin

Intensive phase Continuation

phase

HRZE HRE

75/150/400/275

mg

75/150/275

mg

gm

25-39 kg 2 2 0.5 gm

40-54 kg 3 3 0.75 gm

55-69 kg 4 4 1 gm

≥70 5 5 1 gm

Doses in RNTCP Daily Regimen

Type of TB Case Doses in IP Doses in CP#

New 56 doses (8 weeks x

7 days/week) or

28*2

112 doses(16 weeks

x 7 days/week) or

28*4

Previously treated 84 doses (12 weeks x

7 days/week) or

28*3

140 doses(20 weeks

x 7 days/week) or

28*5

#CP can be extended by 12 to 24 weeks in certain forms like CNS TB, Skeletal TB and Disseminated TB, based on clinical decision of the treating physician

FDC Drugs by Weight

FDCs wrapped in custom 99DOTS envelopes based on weight

(diagrams to follow)

Cat I Cat II

Weight band No. of blisters required in month

IP 4FDC (HRZE)

CP 3FDC (HRE)

IP 4FDC (HRZE) + Inj. SM

CP 3FDC (HRE)

<25kg No blister (loose drugs )

- - - -

25-39 kg 2 blisters (2 pills) 2

pills/day

2

pills/day

2 pills/day +

0.5 gm

2 pills/day

40-54 kg 3 blisters (3 pills) 3

pills/day

3

pills/day

3 pills/day +

0.75 gm

3 pills/day

54- 69 kg 4 blisters (4 pills)

4

pills/day

4

pills/day

4 pills/day +

1 gm

4 pills/day

>70 kg 5 blisters (5 pills) 5

pills/day

5

pills/day

5 pills/day +

1 gm

5 pills/day

2 pills - Yellow

5 pills - Pink 4 pills - Green

3 pills - Blue

99DOTS Envelopes

Inj. Streptomycin

• 15 mg/kg (12–18 mg/kg) daily

• Maximum daily dose 1000 mg

• Patients aged over 50 years may not be able to tolerate more than 750 mg daily

• Similarly, patients weighing less than 50 kg may not tolerate doses above 500-750 mg daily

Key Product Information (Paediatric) (Dispersible FDC)

• Rifampicin 75 mg + Isoniazid 50 mg + Pyrazinamide 150 mg

• Rifampicin 75 mg + Isoniazid 50 mg

(Formulation: Dispersible, flavored —Mango, Strawberry & Raspberry)

• Ethambutol 100 mg

• Isoniazid 100 mg

(Formulation: Dispersible)

9

Drug Dosage for Paediatric TB Weight

category

Number of tablets

(dispersible FDCs)

Inj.

Streptomyc

in

Intensive phase Continuation

phase

HRZ E HRE

50/75/150 100 50/75/100 mg

4-7 kg 1 1 1 100

8-11 kg 2 2 2 150

12-15 kg 3 3 3 200

16-24 kg 4 4 4 300

25-29 kg 3 + 1A* 3 3 + 1A* 400

30-39 kg 2 + 2A* 2 2 + 2A* 500 *A=Adult FDC (HRZE = 75/150/400/275; HRE = 75/150/275)

Drug Doses wheel – adult

Drug Doses wheel - Pediatric

Pyridoxine in TB Regimen

• Tab pyridoxine not required for all TB patients

• To prevent INH related neuropathy in persons at high risk of Vitamin B6 deficiency

– Alcoholics

– Malnourished persons

– Pregnant and lactating women

– Patients with conditions such as chronic renal failure, diabetes,

• While treating NTM

13

• Himachal Pradesh • Sikkim • Bihar • Maharashtra • Kerala

Rollout of Daily Regimen in 104 districts/5 States Total population

coverage - 2,690 Lakh

Rajas than

Gujarat

Maharas htra

Oriss a

Karnataka

Madhya Prades h

Bihar

Uttar

Pradesh

Jam m u &

Kas hm ir

Tam il Nadu

Assam

Telangana

Chhattis garh

Andhra Pradesh

Jhark hand

Punjab

W est B engal

Kera la

Haryana

Himac hal

Pradesh

Manipur

Mizoram

Andam an & N icobar

Dam an & Diu

Uttarakhand

Sikkim

Arun acha l

Prad esh

N aga lan d

Tr ipura

Gujarat – June’2017

M

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N

T

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W

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D

T

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U

F

R

I

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A

T

S

U

N

M

O

N

T

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W

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Operational steps for transition

Intermittent to Daily

ICT in treatment adherence

Information Communication

Technology

How To Login?

1. Go to 99dots.org and then Click Login.

2. Enter the username and password provided to login to the 99DOTS web site.

17

99dots.org

What is 99DOTS?

• Anti-TB drugs are wrapped in envelopes which are printed with hidden numbers behind the pills

• When patients dispense a dose, they reveal a hidden TOLL FREE number which they call

• This call gets reflected on the 99DOTS dashboard immediately as a taken dose

Goal: to provide 99% of the benefits of DOTS at a fraction of the cost and inconvenience to patients

19

99DOTS: Accurate Monitoring at Very Low Cost

Calendar View of Adherence

SMS Alerts from 99DOTS

Analytics and Reports for Program

SMS Message:

[0000] Please take pills

Notification of new patients

New patient (740XXXXXX)

enrolled, Yelahanka district

Two of your patients have missed doses

Raj (979XXXXXX) & Om (812XXXXXX)

SMS Message:

Two of your patients have missed doses today: Raj & Om

[0000] Please

take pills

SMS Message:

[0000] Please take pills

Reminders to Patients Alerts to Staff

Features of 99DOTS

• Calls are completely free for patients • Calls can be made even when the patient has no

pre paid balance or the mobile is in roaming area • Any call from a registered patient number is

marked as a dose taken (personal, shared, land line)

• Numbers are not unique, but appear in an unpredictable sequence – ensures pill-in-hand adherence

• When patients call, they hear “Thank you” • Calls immediately show up in the dashboard as

taken doses • Automatic alerts and reminders to patients and

supervisors for non-adherent patients • Adherence records available to field staff,

medical officers, district staff and all other stakeholders in the program

Two of your patients have missed doses

Raj (979XXXXXX) & Om (812XXXXXX)

SMS Message: Two of your patients have missed doses today: Raj & Om

99DOTS Menu

• Overview: Overview for all patients • Calendar: Month wise adherence calendar

of all patients • Current Patients: List of all current

patients • Past Patients: List of all patients who are

no longer on treatment • Staff Details: Add Staff Details at District

and TU Level • Treatment Supporters: Add Treatment

Supporters Details at District and TU Level • Reports: Download 99DOTS Reports • Profile: View / Edit own profile • Add Patient

Note: There are different login profiles (e.g. ART Login, RNTCP-District Logins, TU Logins). Depending on the profile, the menus appearing on the 99DOTS website will vary.

23

Add a Patient Go to Add Patient from the menu and fill out the form to add a patient. Ensure to select the correct district , the correct primary phone number, and the weight band. It is recommended that you add multiple phone numbers as secondary numbers.

24

Add a Patient Enter the Pre-ART Number, ART Number, Nikshay Id, TB Number, and TB Category if you have the details. Once you enter all details, click the Add patient button.

25

• Assigning Patients to TU under a District

• Maintaining Treatment Supporters Details

• Adding a Treatment Supporter at District/ TU Level

• Viewing/Editing/Deleting a Treatment Supporter at District Level

• Linking Patient’s to a Treatment Supporter

• Difference between Staff and Treatment Supporter

Table of Contents Contd…

26

• What to do when two numbers appears under doses.

99 DOTS

Important information about

calling the toll free number • Make a free call on the toll free

number revealed everyday • Don’t add ‘0’ or ’91’ before the toll free

number • Call can be made with no balance and from

any city and anytime (no roaming charges) • Call for a day’s medication must be

made on the same day • Make calls only from the phone numbers

given to the ART center • Update phone number when you change

your number

99 DOTS

Thanks

Any Question…?