Burma Faces ‘Massive’ Treatment Gap for Drug-Resistant TB

By Paul Vrieze 22 August 2013

RANGOON — Drug-resistant tuberculosis is spreading rapidly in Burma, with an estimated 9,000 new infections occurring every year, but only a fraction of the patients are receiving proper diagnosis and treatment for this dangerous form of TB, Médecins Sans Frontières warned on Thursday.

The medical charity urged international donors, health organizations and governments to come together to curb the spread of drug-resistant TB and improve national treatment programs in Burma and across the globe.

“This a major public health crisis … not just in Myanmar but worldwide, and certainly the number of cases of drug-resistant TB are on the increase,” Dr Sidney Wong, medical director at MSF Holland, told The Irrawaddy on the sidelines of a two-day symposium on drug-resistant TB held in Rangoon.

While 9,000 Burmese are newly infected with the disease every year, according to World Health Organization (WHO) estimates, only 800 patients had received treatment by late 2012.

“The gap is still massive. If we don’t try to make a concerted effort to try and reduce this, the number [of cases] will go up,” Wong warned, adding that Burma’s National Tuberculosis Program should be scaled-up and improved with outside support and funding.

The Ministry of Health first began treatment of drug-resistant TB in cooperation with MSF in 2009. It has since developed a plan to treat some 10,000 cases in 100 townships by 2015 in order to treat neglected cases in remote areas of Burma. It also plans to introduce faster diagnostic tests and to provide TB care in homes in local communities.

The US$55 million plan faces a funding shortfall of some $41 million, however, according to a WHO paper. “There is a massive funding gap; therefore we need to look at how we address that,” Wong said.

Dr Thandar Lwin, manager of the National Tuberculosis Program, said Burma currently has only two laboratories—one in Rangoon and the other in Mandalay—to test patients for drug-resistant TB.

“That’s why we don’t know the exact number of DR-TB patients. We need to expand those labs in other parts of the country … If we could find out the patients, treatment would follow. Labs, funding and resources are the main challenges,” she said.

But Thandar Lwin added, “To build that kind of lab, we need 24-hour electricity supply. Let’s say we build those kinds of facilities in Shan State or Kachin State—there will be infrastructure problems. These challenges are beyond the capacity of the Ministry of Health.”

Tuberculosis is an infectious airborne disease that affects the lungs and can easily spread from person to person. HIV/AIDS patients are at particular risk of contracting TB. Treatment requires the use of a combination of antibiotics.

In recent decades, strains of the disease have developed degrees of drug-resistance, and multiple, extensively and totally drug-resistant forms have emerged around the world, sparking major international health concerns.

India is one of the Asian countries worst-affected by this development, with the extremely dangerous, totally drug-resistant TB making inroads among the population there.

Burma is among a group of 22 countries with the highest burden of TB and an estimated 300,000 people suffer from the disease, according to MSF. Extensively drug-resistant TB has been reported in Burma since 2007.

Dr Anita Mesic, MSF’s HIV/TB co-infection coordinator in Burma, said the most dangerous drug-resistant form had not been found so far. “Totally resistant TB, maybe we do have it here, but we haven’t come to diagnose it yet,” she said.

The MSF medical director Wong said governments, health organizations and the pharmaceutical industry should also ensure that improved medicines become available worldwide for patients with drug-resistant TB.

“We have to find better drugs that have shorter [treatment] regimes and are more tolerable for the patients,” he said.

Medicines that are currently used to treat drug-resistant TB are highly toxic, have serious side effects and need to be taken for a period of up two years, with patients taking up to 20 pills and injections every day, according to MSF. Only half of the patients have a chance of being cured.

Ko Min Naing Oo, a Burmese patient who was cured of drug-resistant TB, described the severity of the current treatment methods in a post on an MSF blog this week.

“I felt dizziness, pain in my buttocks from all the injections, and problems with my hearing. I felt nauseous when I smelt cooking, found myself easily getting angry, constantly weak and tired, always having diarrhea, and experiencing hallucinations,” he wrote.