I have waited for a while after World TB Day to comment on these three stories. New drugs and long treatment for multi drug resistant tuberculosis are interesting issues. But a glance at the graph on page 21 of the global TB report
http://apps.who.int/iris/bitstream/10665/250441/1/9789241565394-eng.pdf
shows that the number of case notifications in Myanmar is flat. No progress is being made. Something has to change. Short course treatment for MDR TB would be a good first step. Then how will Myanmar find all those 'hidden cases'?
Jamie
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New tuberculosis treatment option being piloted in Burma
Libby Hogan
DVB
24 March 2017
A Rangoon pilot programme launched by Medicines Sans Frontieres in Burma is testing a new international access campaign using two new drugs — bedaquiline and delamanid — that are not widely available in countries like Burma that have a high tuberculosis (TB) burden.
The two are radically better drugs than their predecessors, and are to form drug-resistant TB treatment regimens. Patients who have received these drugs have seen dramatically higher cure rates and the new medicines themselves are better tolerated by recipients compared with older TB drugs.
The pilot programme began in 2016 and 20 patients were enrolled last year, with an additional 20 patients this year at a government hospital in Rangoon.
“This is the first time the drugs are being used — for those who do not respond to the normal treatment, their health is not improving, these people may benefit from the new treatment,” an MSF medical coordinator in Burma, Dr. Jarmila Kliescikova, told DVB on Friday, marked globally as World Tuberculosis Day.
Tuberculosis is one of the world’s leading infectious disease killers, claiming 1.8 million lives each year.
According to Kliescikova, “the lack of access to the new drugs requires urgent action from stakeholders,” such as the pharmaceutical companies Janssen, Johnson & Johnson and Otsuka, which could take one step toward solving the problem by widely registering their drugs. Governments also have to ensure that these new, powerful drugs are made more available and affordable, including taking steps to enable generic competition and ensure the new drugs are added to national Essential Medicines Lists.
Globally, just 2 percent of people with the most severe cases of drug-resistant TB have access to new, more effective treatments. Eighty-five percent of TB cases worldwide occur in Asia and Africa.
MSF’s country health director for Burma, Khachatur Malakyan, stresses that “we are diagnosing more and more cases of drug-resistant tuberculosis and for these patients, the new drugs are desperately needed.”
The regular treatments being used in Burma and the rest of the world “have profound side effects,” says Kliescikova. “There are a lot of cases where hearing decreases and some patients can even become deaf, so regular monitoring is needed. A lot of patients also complain of nausea because of the strong metallic taste of some of the drugs, which have to be taken for up to 20 months.”
Daily injections are also common in regular treatment. “It is very painful for patients to be receiving — for up to six months — daily injections. There are also some cases of people having psychiatric problems.”
With the new drugs, MSF says they aren’t seeing these side effects and with the new treatment regimens daily injections are avoided.
Awareness-raising is also key to reducing the numbers of TB in Burma. “Unfortunately, the spreading of TB comes with a stigma,” says Kliescikova. “Because TB is an airborne disease, many family members are afraid to go near the patient. People don’t want to go in the same room because taking certain measures, [such as] wearing a mask, is uncomfortable.”
As well as the new two-drug pilot, MSF is also working with the national TB programme in initiatives focusing on diagnosis, treatment and counselling.
http://www.dvb.no/news/new-tuberculosis-treatment-option-piloted-burma/74777
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TB efforts stepped up
Nay Rai and Kyaw Myo
Eleven on Sat, 03/25/2017 - 18:21
It is estimated that Myanmar has about 200,000 new tuberculosis (TB) patients every year and around 150,000 of them were provided "free" medical treatment last year, said Professor Thet Khaing Win, permanent secretary for the Ministry of Health.
“Of Myanmar's 51.4 million population, about 200,000 people were estimated to be infected with TB annually. Around 150,000 patients were diagnosed and treated in 2016. So we should accelerate our efforts to find the remaining patients and give medical treatment,” he said.
An official ceremony organised by the Ministry of Health to mark World Tuberculosis Day 2017 was held on March 24 in Nay Pyi Taw.
According to the World Health Organisation (WHO), Myanmar had 457 new TB cases per 100,000 people and 53 deaths in 2014, said the permanent secretary. The WHO Global Tuberculosis Report 2016 said Myanmar had 365 new TB cases per 100,000 people and 49 deaths.
Around 8.5 per cent of new TB patients diagnosed in 2014 were found to be infected with HIV, according to a survey.
The ministry was providing medical treatment for 1,000 drug-resistant TB patients in the fiscal year 2014-15, 1,200 drug-resistant patients in 2015-16 and 1,200 in 2016-17.
Currently there are bio-safety level three laboratories for drug-resistant TB patients in Yangon, Mandalay and Taunggyi and another similar laboratory was planned in Mawlamyaing this fiscal year.
The government is also increasing funding from Ks14 million 1995-96 to Ks3.8 billion in 2016-17.
Yangon Region tops the lists of drug-resistant TB with more than 1,300 patients this year, said Dr Zaw Myint, a TB specialist.
"The average TB transmission rate is 5 per cent in other regions and states but the Yangon rate is 11 per cent. TB transmission is reported mostly in Hlaingtharyar, Shwepyithar, South Dagon, North Dagon and North Okkalapa townships. It is because these townships are the populous,” Zaw Myint added.
http://www.elevenmyanmar.com/local/8471
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How Heroes are Fighting Tuberculosis in Burma — and Winning
Matt Grieger
USAID
Sa Aung Win was 32 when he first noticed the fever. Then the headache. Then he started coughing up blood. After 20 months of treatment for multidrug-resistant tuberculosis (MDR-TB) — during which he had to take 14,000 pills — Sa Aung Win is now TB-free.
Crucial to his recovery were regular visits by peer counselors — individuals who fought their own TB infection and won. These counselors are part of a network supported by USAID, FHI 360 and the Government of Burma.
Sa Aung Win knew that when he defeated the disease, he wanted to help others do the same.
“The most common complaint from TB patients is that they do not want to take the TB drugs,” Sa Aung Win said. “They do not want to suffer the side effects of loss of appetite, nausea, joint pain, dizziness and hearing loss.”
Sa Aung Win beat MDR-TB and is now a peer counselor with a USAID-supported network helping others fight the disease. / Matt Grieger, USAID
“I visit them and tell them that I had the same symptoms when I was taking the TB drugs, but I never gave up and continued the treatment.
They believe TB is incurable and they feel hopeless and depressed.
However, when they see me, they realize their disease can be cured.” — Sa Aung Win
The married father of two earns no salary for his work as a peer counselor and typically visits six TB patients a week. The peer counselors use mobile phones pre-loaded with videos that show TB patients how to take their medicine. The phones are also equipped with a system for volunteers to upload visit reports noting each patient’s condition and progress.
Sa Aung Win is supported by his family and neighbors, who also play a vital role in combating TB.
“My whole family helps me help others fight the disease. My neighbors direct suspected TB patients to me. I take them to the hospital to get tested and encourage them to take their medicine.” — Sa Aung Win
An approach that harnesses the community is crucial in Burma, a country the size of Texas with 54 million residents. Despite its large area and population, and although MDR-TB is the most deadly infectious disease in the world, Burma has just two dedicated TB hospitals.
The World Health Organization estimates there were 9,000 new MDR-TB cases in 2015 in Burma, with more than two-thirds going undetected. The peer counselors are on the front lines of this battle and are helping to close this gap. And once they have succeeded in identifying and referring potential TB cases for diagnosis and treatment, U.S. technology is helping save lives.
A technician uses a GeneXpert machine to test for TB at a USAID-supported hospital in Rangoon, Burma. / Matt Grieger, USAID
Rapid testing machines from California-based company Cepheid are dramatically slashing TB testing times. Before the U.S. Government and other funders donated the GeneXpert machines, some of which are solar-powered, it took up to 90 days for patients to receive their TB test results — meaning they could unknowingly spread the airborne disease while they waited. Now testing takes less than two hours.
USAID is helping the Government of Burma expand its TB detection capabilities through enhanced laboratory testing and faster transportation of samples. The government plans to deploy portable, lightweight GeneXpert machines that health workers and volunteers can take to remote villages so individuals need not travel long distances to obtain a TB test.
A GeneXpert machine diagnosed Kyaw Swar Win’s MDR-TB, giving her a jumpstart on the required 20 months of treatment. She was thin and clearly unwell when I met her last June in a USAID-supported TB hospital on the outskirts of Rangoon, Burma’s largest city. Although she had just begun treatment and was suffering from side effects, she patiently answered my questions, sitting quietly on her bed.
It was brutally hot and humid. Stray dogs wandered in and out of the patients’ open-air rooms, tracking in mud from the courtyard. Each of the 10 rooms in the MDR-TB/HIV co-infection ward was sparsely furnished with an ancient-looking metal bed frame, a thin mattress and a small nightstand.
Kyaw Swar Win speaks to USAID in her hospital room at Aung San TB Hospital. / Matt Grieger, USAID
Kyaw Swar Win, 32, is also battling HIV, for which she has been making the 16-hour round-trip journey from her hometown to Rangoon for the last five years to receive treatment. As a gay man who identifies as female, she faces stigma and discrimination from her neighbors.
“They say I am suffering from these diseases because I am gay and do not behave like a real man,” Kyaw Swar Win said. “However, my aunt understands all my sufferings and she does not have any such stigma against me. Because of her understanding and support, I have been able to recover.”
Although Kyaw Swar Win is still undergoing treatment and cannot officially serve as a peer counselor, she is finding ways to support others fighting TB.
“During my visits to the clinic to receive the anti-HIV drugs, I have helped TB patients whom I have met in the clinic,” she said.
“They did not have much knowledge on where to get treatment and support, so I directed them where to go.” — Kyaw Swar Win
USAID’s staff in Burma spoke with Kyaw Swar Win three months after our initial meeting and found her in better health.
“I am putting all my effort into undergoing treatment. I am feeling better and have gained a lot of weight. I now want to dress up, wear makeup, and be pretty again.”
Myint Myint Kyu from USAID/Burma contributed to this story.
About the Author
Matt Grieger is the Deputy Team Leader for Outreach and Communications in USAID’s Asia Bureau.
https://medium.com/usaid-2030/how-two-heroes-are-fighting-tuberculosis-in-burma-and-winning-9a94b43552e3?_hsenc=p2ANqtz--yfN88E1ZrRYVyBoZhq0r9Xti5TrOXDBF2yVIXCXcpbtoPyWqy0anGTD7XcSwRmG5Xb1SpYXRvqBPmQoWuxkJ5GURjTQ&_hsmi=49261128#.2f8hmbd4a
