{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T04:19:02Z","timestamp":1774844342698,"version":"3.50.1"},"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2023,12,14]],"date-time":"2023-12-14T00:00:00Z","timestamp":1702512000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001411","name":"Indian Council of Medical Research","doi-asserted-by":"publisher","award":["No 50\/2\/TF-CVD\/2019-NCD-I"],"award-info":[{"award-number":["No 50\/2\/TF-CVD\/2019-NCD-I"]}],"id":[{"id":"10.13039\/501100001411","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Antihypertensive drug supply is sometimes inadequate in public sector health facilities in India. One of the core strategies of the India Hypertension Control Initiative (IHCI) is to improve the availability of antihypertensive drugs in primary and secondary care facilities. We quantified the availability of antihypertensive drugs in 2019\u201320 and described the practices in supply chain management in 22 districts across four states of India.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Twenty-two districts from 4 states (Punjab, Madhya Pradesh, Telangana, and Maharashtra) were studied. We described the practices and challenges in supply chain management. We collected data on drug procurement from 2018 to 2020 and drug availability from April 2019 to March 2020. Quantity procured, the proportion of facilities with stockout at the end of each quarter, and availability of drugs in patient days were tabulated.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>All states selected drug- and dose-specific protocols with Amlodipine as the initial drug and shifted to morbidity-based forecasting. The total number of antihypertensive tablets procured for the 22 districts increased from 16 million in 2017\u20132018 to 160 million in 2019\u20132020. The proportion of facilities with Amlodipine stock-out was below 5% during the study period. Amlodipine stock was available for at least 60 patient days from the third quarter of 2019 onward in all districts.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This study demonstrates that including best practices can gradually strengthen the procurement and supply chain for antihypertensives in a low-resource setting. As the program was rapidly growing, there were still gaps in the procurement and distribution system which needed to be addressed to ensure the adequacy of drugs. We recommend that best practices, including choosing a single protocol, basing supply on projected patient load rather than an increment from historical levels, and using simple stock management tools, be replicated in other districts in India to increase and sustain coverage of hypertension treatment.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0295338","type":"journal-article","created":{"date-parts":[[2023,12,14]],"date-time":"2023-12-14T18:39:56Z","timestamp":1702579196000},"page":"e0295338","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Improving the availability of antihypertensive drugs in the India Hypertension Control Initiative, India, 2019\u20132020"],"prefix":"10.1371","volume":"18","author":[{"given":"Abhishek","family":"Kunwar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2605-3739","authenticated-orcid":true,"given":"Prabhdeep","family":"Kaur","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiran","family":"Durgad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ganeshkumar","family":"Parasuraman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meenakshi","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sudhir","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Balram","family":"Bhargava","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"on 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Attaei","year":"2017","journal-title":"The Lancet Public Health"},{"issue":"5","key":"pone.0295338.ref006","first-page":"645","article-title":"Prices & availability of common medicines at six sites in India using a standard methodology","volume":"125","author":"A Kotwani","year":"2007","journal-title":"Indian journal of medical research"},{"issue":"1","key":"pone.0295338.ref007","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s40360-015-0043-8","article-title":"Availability of medicines in public sector health facilities of two North Indian States","volume":"16","author":"S Prinja","year":"2015","journal-title":"BMC Pharmacology and Toxicology"},{"issue":"12","key":"pone.0295338.ref008","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1111\/tmi.13494","article-title":"Availability, price and affordability of essential medicines for managing cardiovascular diseases and diabetes: A statewide survey in Kerala, India.","volume":"25","author":"G Satheesh","year":"2020","journal-title":"Tropical Medicine & International Health."},{"issue":"1","key":"pone.0295338.ref009","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12913-021-06530-0","article-title":"Preparedness of primary and secondary health facilities in India to address major noncommunicable diseases: results of a National Noncommunicable Disease Monitoring Survey (NNMS).","volume":"21","author":"A Krishnan","year":"2021","journal-title":"BMC health services research."},{"key":"pone.0295338.ref010","author":"World Health Organisation","year":"2017","journal-title":"Cardiovascular disease -HEARTS technical package Geneva: World Health Organisation"},{"key":"pone.0295338.ref011","article-title":"Equitable access to essential medicines: a framework for collective action.","author":"World Health Organisation","year":"2004","journal-title":"Geneva"},{"key":"pone.0295338.ref012","volume-title":"Role of National Health Mission in Health Spending of States: Achievements and Issues","author":"M Choudhury","year":"2020"},{"key":"pone.0295338.ref013","author":"John Snow Inc","year":"2017","journal-title":"The supply chain managers\u2019s handbook\u2014A practical guide to the management of health commodities Arlington, VA: John Snow Inc,;"},{"key":"pone.0295338.ref014","article-title":"The India Hypertension Control Initiative\u2013early outcomes in 26 districts across five states of India, 2018\u20132020.","author":"P Kaur","year":"2022","journal-title":"Journal of Human Hypertension."},{"key":"pone.0295338.ref015","author":"ICMR-NIE","year":"2021","journal-title":"India Hypertension Control Initiative: State Hypertension Protocols: ICMR-NIE, Chennai"},{"key":"pone.0295338.ref016","volume-title":"Guideline for the pharmacological treatment of hypertension in adults","author":"World Health 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