TB Program to Launch in Burma

By MIN KHET MAUNG

RANGOON—A pilot program to treat multidrug-resistant tuberculosis (MDR-TB) is due to be launched next month in Burma, which is one of 22 countries in the world most affected by the disease, according to health agencies.

Tuberculosis (TB) is one of the world’s most dangerous diseases. More than eight million people worldwide become infected with TB every year and more than two million die, usually in developing or underdeveloped countries. The World Health Organization (WHO) estimates that one-third of the world’s population—more than two billion people—have been exposed to the TB pathogen.

TB is spread by germs in the air from person to person—most commonly through sneezing, coughing or spitting—and generally attacks the pulmonary system causing chronic coughing.

However, it can be successfully cured with prolonged treatment of antibiotics, usually rifampicin and isoniazid, which are considered the first-line drugs in the fight against TB.

MDR-TB is a strain of the disease which is resistant to the first-line drugs.

The two-year pilot program to combat MDR-TB will be conducted by the National TB Program (NTP), the WHO and Artsen Zonder Grenze (AZG).

According to an NTP survey in 2007, between 800,000 and 900,000 people in Burma become infected with TB annually, out of which only about 130,000 are admitted as patients. Of this number, approximately 4.2 percent of all new cases and 10 percent of re-treated cases are MDR-TB patients.

According to sources, the cost of drugs for each MDR-TB patient will be nearly US $5,000 for two years. The patients on the program would enjoy free meals and free accommodation, plus their transportation fees would be refunded while they were attending the hospital.

However, not everyone with MDR-TB will qualify for the pilot program. Initial treatment will only be carried out in selected townships in Rangoon and Mandalay. The program seeks to treat 100 MDR-TB patients over a 24-month period.

“The number of MDR-TB patients we will treat in this pilot program is comparatively small in a country where the MDR rate is pretty high,” an INGO official said. “But, this is a good start, and hopefully we will be able to treat more and more people in the near future based on the experience we learn from this [pilot phase].”

The five townships in Rangoon that will be included in the program are Hlaing, Shwepyithar, Hlaing Tharyar, Insein and Mayangone, while the Mandalay program will treat MDR-TB sufferers from Aungmyaytharzan, Chanmyatharzi, Chanayetharzan, Mahaaungmyay and Pyigyitagon townships.

One health worker involved in the pilot program said that they have to choose only those MDR-TB patients who live close to the hospitals where the treatment will be conducted, so they can come regularly and without fail.

"If a certain patient is coming from a faraway area, it's not certain whether he or she can be punctual and receive the treatment on a regular basis due to transportation difficulties,” the health worker said.

"If a patient fails to come on time, the disease can manifest into XDR-TB (Extensively Drug Resistant TB) from a strain of MDR-TB,” he said.

He added that future MDR-TB treatment programs will be able to treat many MDR-TB patients across the nation, based on the accomplishments from this pilot program.

However, since only those who live in the above-mentioned designated townships are eligible to receive treatment, other MDR-TB patients are worried about their health, not knowing what to expect of the future.

"How can we spend over 300,000 kyat (nearly $300) every month to treat our brother?" said a woman who looks after her MDR-TB infected brother at a government health facility in Rangoon.

As her brother's health did not improve over time in their native town, she brought him to Rangoon to have his TB condition treated and cured. However, the diagnosis showed that her brother was resistant to multi-drugs and she was told she would have to pay 300,000 kyat each month on drugs to treat him for MDR-TB.

News of the pilot program offered little relief.

“I was so sad when I heard that we, coming from outside Rangoon, are not eligible for treatment,” the woman said.

On April 10, The Irrawaddy reported that Burma is facing a serious shortage of TB drugs as its current supplier, the Global Drug Fund, will end its support at the end of 2009.