23 September 2010 - Urgent action is needed to prevent the spread of multidrug-resistant tuberculosis in Myanmar due to the current HIV and tuberculosis epidemics, warned Dr Philipp du Cros from Médecins Sans Frontières (MSF) during an informal presentation to 3DF staff on 21 September.

“The large numbers of people living with HIV who are in need of antiretroviral treatment, and the high prevalence of TB in Myanmar, make the country more susceptible to a rapid spread of MDR TB”, explained Dr du Cros. “They are very immuno-suppressed and at high risk of contracting TB.”

Myanmar is one of the 22 WHO ranked high tuberculosis countries and one of 27 high multidrug-resistant tuberculosis (MDR TB) burden countries in the world. In addition, it is estimated that in 2009 there were over 240,000 people living with HIV in the country, with at least 75,000 in need of urgent antiretroviral treatment. TB HIV co-infection is a growing concern in Myanmar.

MSF are concerned about the current high death rates in TB-HIV co-infected cases without access to diagnosis of MDR TB. Dr du Cros urged that rapid diagnostic tests are needed for all projects in the field to allow for the effective diagnosis and faster treatment of MDR TB.

Further action needed to reduce the spread of MDR TB includes implementing TB infection control measures at all health facilities, an increase in prequalified suppliers for MDR TB drugs, better models of field implementation, more and better research into new drugs and diagnostic tests and control of TB drug availability outside of the use of approved programmes.

Importantly, many of the measures needed are not costly, therefore they are feasible to implement without increasing resources. Good ventilation and air flow in all hospital wards, not just those with TB patients, and ensuring all lab technicians are wearing high-filtration masks during sputum examination can significantly reduce the spread of life-threatening MDR TB. Most important is the rapid diagnosis and early commencement on effective treatment for TB and MDR TB, and the scale up of antiretroviral therapy to reduce the risk of developing TB in people living with HIV.

3DF was a supporting partner of the 2009 National TB Prevalence Survey which mapped the disease countrywide. The survey showed that while there is a high prevalence of TB in Myanmar, there is clear evidence the national TB programme is working, but it needs to be more targeted and more effective to control TB.

Since 2009, 3DF has been funding Myanmar’s first MDR TB pilot programme in Mandalay and Yangon. The National Tuberculosis Programme is working with MSF Holland and WHO, while the drugs are being provided with support from UNITAID. As of September 2010 there are 125 patients enrolled and early results are very good. The National TB Reference Laboratory in collaboration with the Fund for Innovation and New Diagnostics (FIND) are currently introducing rapid MDR TB diagnostic tests. This will be gradually scaled up, receiving sputum samples beyond pilot townships from late 2010.

However, the pilot phase alone cannot solve this problem. A scaling up of treatment for multidrug-resistant tuberculosis needs to be a collaborative effort of all the stakeholders in Myanmar.