Impact of Implementing a Novel Anti-Tuberculosis Treatment Stewardship Program from a Tertiary Care Center in Kerala, India

Introduction: The private sector contributes to more than 50% of tuberculosis (TB) care. Inappropriate anti- TB drug prescriptions are a significant factor in drug-resistant TB. Effective engagement of the private sector, in partnership with the national TB control program, is essential for achieving TB elimination. Here, we share the experience of successfully implementing a novel administrative intervention called the anti-TB Treatment Stewardship Program (ATTS) to improve the standards of TB care. Objective: The objective is to evaluate the effectiveness of an anti-TB treatment stewardship program in a tertiary care center for improving the standards of TB care. Methodology: The hospital formed a team called the “ATTS Team,” led by a medical superintendent and comprising a pulmonologist, a physician, and clinical pharmacists. The team audited all anti-TB prescriptions and assessed the appropriateness of each prescription according to the 4Rs of medication safety: Right Indication, Right Drug, Right Dose, and Right Frequency. If any of the 4Rs were incorrect, the team would provide recommendations to the primary consultant. Results: Out of 358 cases with private anti-TB prescriptions, 60.89% were extrapulmonary TB, and 39.10% were pulmonary TB. The proportion of microbiologically diagnosed TB cases increased from 52.23% to 60.44% during the study period. There were 257 (71.78%) appropriate prescriptions and 101 (28.21%) inappropriate prescriptions. When the 2-year data were compared, inappropriate prescriptions decreased from 38.15% in 2017–2018 to 18.90% in 2018–2019. Appropriate prescriptions increased from 61.84% in 2017–2018 to 81.1% in 2018–2019. Compliance with recommendations also increased during the study period. Conclusion: Effective stewardship policies can improve the standards of diagnosis and treatment for TB.