1. Working together to rationalize the use of Anti-TB drugs GROUP 5 Facilitators: Dr Andrey Zagorkiy, MSH and Dr Knut Lönnroth, WHO/HQ

2. Summary of Discussion Great variation in country scenarios: –One extreme: NTP monopoly, TB drugs not available in private market, no domestic market –Other extreme: Private sector dominates 1 st and 2 nd line drugs, NTP controls fraction, huge domestic market that is protected by domestic laws, everything available in private markets, (with or without prescription) Lack of data on magnitude, quality of prescription, quality of drugs, in relation to treatment outcome (and ADR) Any effort to improve RUD requires involvement beyond NTP, wider health systems and regulatory issue We mapped role of professional association along the steps of rational use: Quality prescription – drug quality – quality of dispensing – quality supervision, recording and reporting (including ADR)

3. Activities for professional associations to contribute to rational use of TB drugs Intervention areaWhat associationWhat action Information, education, and quality of prescriptions Medical Pharmacy Nurses Paramedics Pharmaceutical industry -Undergraduate training -CME -Publications -Involved in reviews -Involved in programme planning -Restricting prescription rights to special groups Quality of drugsPharmaceutical industry-GMP -Involvement in regulation and policy Quality of dispensingPharmacy Medical -Accreditation of pharmacies - correct staff with correct qualification -Promote dispensing only correct prescription, in full -Restrict dispensing to only certain pharmacies Monitoring of treatment: Treatment outcomes and adverse drug reactions Medical Pharmacy -Standard supervision, recording and reporting -ADR reporting / pharmacovigilance

4. Conclusion Need for country and regional specific approaches Need of better data on current situation Important to map and involve wide range of professional associations and other stakeholders outside NTP to improve rational use of drugs Involve these stakeholders in development of NTP plans, including MDR national plans (for example in 27 MDR high priority countries in preparation for the MDR meeting in China)