More work needed in Myanmar on drug-resistant TB

Struggling to breathe, Burmese migrant Tun Aung Kyaw sits up slowly in bed for a routine check-up at a Thai tuberculosis (TB) clinic along the 1,800km Thai-Burmese border.

This is the third round of treatment for the 29-year-old, who believes Burmese health workers misdiagnosed him with regular TB twice when he actually had multi-drug-resistant TB (MDR-TB), a form of the infectious disease harder to diagnose and cure.

“Even though I was on TB treatment I got weaker and eventually I was bed-ridden,” Tun Aung Kyaw told IRIN.

After 14 months of treatment, Tun Aung Kyaw's condition never improved as the disease had destroyed his left lung. He now faces a two-year regimen of care to see if he can finally defeat the MDR-TB strain, which has a treatment success rate of almost 60 percent in South-East Asia, according to the Global Tuberculosis Report 2012 by the World Health Organization (WHO).

Inadequate detection and treatment are major obstacles and can result in cases of drug-resistant TB (DR-TB) such as MDR-TB, say health experts.

"Drug-resistant TB is a very significant health concern for Myanmar,” Peter Paul de Groote, the country’s head of mission for Médecins Sans Frontières (MSF), told IRIN.

Around 8,900 new cases of DR-TB are reported each year, but only 800 patients had access to treatment at the end of 2012, he said.

TB burden

Myanmar is among the world’s top 22 TB-burden countries with a prevalence rate of 525 cases per 100,000 people, more than three times the global average.

It is also a high burden country for MDR-TB, a complex strain immune to first-line drugs that requires two years of treatment, four times longer than non-resistant TB.

MDR-TB treatment costs nearly US$5,000 per patient, roughly 100 times more than the regular strain, according to an October 2012 WHO report.

From 22 to 23 August, WHO, along with MSF and Myanmar’s Ministry of Health, plan to hold a DR-TB symposium in Yangon aimed at ramping up services throughout the country, including neglected border regions.

"There are immense challenges in providing DR-TB treatment, and health care in general, to the remote border areas of Myanmar,” de Groote said.

Health experts fear countless more cases remain hidden in rural eastern Myanmar where armed conflict, rough terrain, lack of awareness and scarce health care can discourage TB-infected people from seeking care.

Proposed approaches for battling DR-TB include counselling to help patients cope with long and toxic courses of treatment, decentralized care in home communities, and rapid diagnosis to treat patients correctly and prevent further cases.

To do this, Thandar Lwin, manager of Myanmar’s National TB Programme, has urged the Burmese government to step up efforts to support TB measures, 94 percent of which are donor funded.


“The government budget is not enough and it is difficult to increase more than the previous year,” she said during an international TB workshop earlier this year. “There is a need for evidence to persuade the government that investment in health is worthwhile.”

In 2013, Myanmar is projected to have a US$22 million funding gap for TB care and control services, the WHO report said. On the other hand, rapid economic growth may help ease the problem in the longer term.

Border run

Many Burmese are forced to seek TB care at donor-funded clinics along the Thai border, home to roughly one million migrants and displaced persons.

Two health clinics run by Shoklo Malaria Research Unit (SMRU), a Mae Sot-based field station for the Mahidol University-Oxford University Tropical Medicine Research Programme in Bangkok, offer free treatment and are inundated with patients.

From 2010 to March 2013, SMRU supported more than 810 TB patients, but had to refer 70 percent of them, and pay for their care at local Thai hospitals due to limited capacity.

About 18 percent of patients tested for first-line drug susceptibility at SMRU clinics had some form of DR-TB. Almost half have already been successfully treated, with others still on the regimen.

In June 2013, SMRU opened a specialized TB clinic in the village of Wangpha, near the Thai border town of Mae Sot, to handle the overflow. Plans are also under way to expand in-patient care at the second clinic since 60 percent of TB patients, especially those with drug resistance, need to be supervised by clinic staff.

Sein Sein, manager of the TB clinic, said several patients initially came in after showing symptoms for several months, when treatment should be sought if persistent coughing lasts for at least two weeks.

“Many patients only come for treatment when they are really sick, so they stay in the community and continue to spread the disease,” she said.

According to WHO, there were an estimated 650,000 cases of MDR-TB among 12 million TB cases worldwide in 2012.

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